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1 . SRWAU <br /> Distance to Public Sewers /1% ` Connection necessary: Yes No_. <br /> Does existing septic system comply with Ord. #549 : Yes No_ <br /> Unknown If no, explain: <br /> Deseri�b septic, install tin o 'be installed: <br /> 2. VATER SUPPLY <br /> Is water supplied by private well : Yes 'No Is well proper: <br /> Yes No State def iciency <br /> Does . existing or porposed use make this well public water: Yes <br /> No Sample Sample of well water taken: Yes— No Datp taken <br /> Results // Additional information or comments . h� -r .tel' <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed dispo841 ��thod: <br /> Potential problem: <br /> 4 . FLY . MOSOUTTO OR VECTOR PUE2,NTIAL <br /> State possible vector potential & necessary control: _/✓'' <br /> 5 . TOILET/BATH FACILITES <br /> No. & location existing: � Additional <br /> facilities needed <br /> 6. PREVTOOS (; ERATTON HISTORY <br /> 7 . GENERAL SANITATION <br /> State any problems not previously noted: <br /> 3 . POPULATION DENSITY <br /> Appx. No . People per sq. mi. -- <br />