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�. . SF�WAGF <br /> Distance to Public Sewers Connection necessary: Yes No Z <br /> Does existing septic system comply with Ord. 11548 : Yes= No— <br /> Unknown If no, explain: ' <br /> ' I <br /> -4 exrg:.; sum_ 4,,sine /10 U("-dr SD%Y-e I'l&a-aa a <br /> De tribe septic installation to *be inat lied: <br /> c S of r Z/ . .o►r fr�Uri' 265k 5y 5- <br /> old a6/e r' ^- -6ra�ra s sem^ <br /> ✓PS <br /> 4- 2d 0,4 f `/(1D �PGIG�i �1c-f �•�s�� J� �/�� . <br /> 2 . WATER SUPPLY <br /> Is water supplied- by private wall: Yes ' X, No Is well proper: <br /> Yes.— No - State def icien y:_ 6'-AzMW' <br /> �Lue2P cAtZ 6ioa L-`p 40 Orr"-f-treEf_ <br /> A4 UeV W1 r "�d c P d;u LL-Ad rid <br /> Does existing or porposed usea this well public Water: Yes <br /> No Sample of well water tmlhi: Yes No Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE Rc REFUSE <br /> Licensed scavenger pick--up: Yes No Service Area No. <br /> Other proposed disposal metood <br /> Potential problem: Elk- -,-- <br /> 4 . MQ�OUITO CR VE^TOR POT BNTIAL <br /> State pos§Able vector potentiftl ez necessar cont ol: <br /> rd.. <br /> 5 . T_QILETZBATH 'FACILITES <br /> No. -.& location• existing: NIA Additional <br /> facilities needed <br /> s. n2 OPEELTIQU HT5TQRX <br /> State any problems not pr �ous?.y noted: ' <br /> Appx. No. People per .,sq'. mi. <br />