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� . SFkWAQzE <br /> Distance to Public Sewers Connection necessary: Yes No `✓ <br /> Does existing septic system comply with Ord . 0549 : Yes No <br /> Unknown If no, explain: <br /> Describe septic installation to 'be installed: <br /> 2. WATER SUPPLY <br /> Is water supplied by private well : Yes --- No— Is well proper: <br /> Yes Bio -'" State deficiency: <br /> Does e, .4Ar ting or porposed use make this well public water: 'Ies <br /> No // Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments--4'ajJ 0 .O� <br /> ., I r t,< <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method:_ <br /> Potential problem- <br /> 4. <br /> roblem:4. FLY. MOSQUITO OR V QT0R ZCi rZN IAL <br /> State possible vector potentiftl PA necessary control: <br /> 5 . TnTLET/BATH FACIA 'FS <br /> No. & location existing: Additional <br /> facilities needed <br /> 6. PRFVTons OPERATToN HISTngy , <br /> b <br /> 7 . GENERAL SAIIIJA1.TON ,------�m <br /> State any problems not previous1v noted: <br /> 8 . POPULATION, DENSTIX <br /> Appx. No . People per eq. mi. <br /> 5 z t� fit/' �Y! <br /> l I <br /> � },.� 46r t'� <br />