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.7a <br /> 1 . aEWAG E <br /> Distance to Public Sewers Connection necessary: Yes Not" <br /> Does existing septic system comply with Ord. #549 : Yes No-4.--- <br /> Unknown- 1f no, explain : <br /> Describe septic in tallation to be installed: <br /> Cj <br /> 2 . MATER EUEEItY / <br /> Is water supplied by private well : Yes 110 ✓ Is well proper: <br /> Yes No State deficiency: <br /> Does existing or purposed use make this well public water: Yes f/ <br /> No Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE ,.$G...._REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> OtYieraposed disposal method:Potent 1 problem: <br /> 4 . F1JL i ECTC)R PCS' =NTIAL <br /> State Possib ve'etor potential & ne ssary control: <br /> 5. TG.LLFTfBATH_ FACIL= <br /> No. k location exi�:tirna: -- Additional <br /> facilities needed <br /> B . <br /> f SAN/PATTOM <br /> State any roblems not previously noted: <br /> 3 . EOPULATIM DEN= <br /> Appx. No. People per sq. mi . <br /> S• <br />