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1 . SKWAGE <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 cz 3 <br /> Is water supplied by private we Yes o Is well proper: <br /> Yes.�No S <br /> � a e Z ,��� � �. <br /> Does ex sting or po posedOuac make thl we�� Pj` 11c Water: <br /> No Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> e <br /> 3 . <br /> Licenced scavenger pick-up:--T <br /> ea No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem:_ i <br /> 4 . FLY, MOSOUTTO QE VECTOR POrENTJAI, <br /> State possible vector potentir►1 8z necessary control: <br /> 5 . TQr_LET/BATH LACTLITES <br /> No. & location existing : �` Additional <br /> facilities needed._. <br /> 6. PREVTOUS QEERAIION HISTORX <br /> 7 . UENERAL SAN TIATTON <br /> State any prot)lems not previously noted: <br /> 8 . POP 1 .ATTON DE° ST Y � ✓ <br /> Appx . No . People per sq. Lei . <br />