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r <br /> Distance to Public Sewers Connection necessary: Yes No _ <br /> Does existing septic system comply with Ord. 6549: Yes No Unknown <br /> If no, explain: <br /> Describe septic installation to be installed: <br /> Additional information or comments: <br /> 2. WATER SUPPLY <br /> Is water supplied by private well: Yes _ No _ Is well proper: Yes No <br /> State deficiency: <br /> Does existing or proposed use make this well public water: Yes _ No. <br /> Sample of well water taken: Yes _ No Date Taken Results <br /> Additional information or comments: <br /> 3. GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes _ No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 14. FLY, MDSQUITO OR VECMR POTENTIAL <br /> State possible vector potential & necessary. control: - <br /> 5. AIR PO LLU TION PO TEN TIAL <br /> State possible burning or processing pollutants & necessary control: <br /> 6. TOILET/BATH FACILITIES <br /> No. & location existing: Additional facilities needed <br /> 7. PREVIOUS OPERATION HISZO RY <br /> �. GENERAL SANITATION <br /> State any problems not previously noted : <br /> 9. f 0i'ULATION DENSITY <br /> Appx. No . People per sq. mi. <br />