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1 . SQL <br /> Distance to Public Sewers Connection necessary: Yes No_ <br /> Does existing septic system comply with Ord. #549 : Yes No_ <br /> Unknown If no, explain: <br /> Describe septic installation to be installed: <br /> Z . WATER SUPPLY <br /> Is water supplied by privata ;cell : Yes ido Is crell proper: <br /> Yes No State deficiency : <br /> Does existing or porposed use make this well public water: Yes <br /> No Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments - <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up : `.'es No Service Area No. <br /> Other proposed disposal method: _ <br /> Potential problem: <br /> 4 . FLY. MnsouTTn QR 7ECTOR PO'fLN'T'TAT <br /> State possible vector potential necessary control: <br /> 5 . TOTT FTIRATH 7ACTT,TTES <br /> No . & location existing: Additional <br /> facilities needed <br /> 6 . PRFVTnnS n RgATTOPJ HT;TngX <br /> 7 . GENERAL SA'7TTATTOU <br /> State any problems not Prev'OU'3ly noted : <br /> 8 . P_nPiTT AmT!-iia nr'N;,TTV <br /> Appx . N70 . Pe-ple per ac mi <br /> 1 <br />