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z ` <br /> q�'°3. ' 2 <br /> Af <br /> � . SK <br /> Distance to Public Sewers Connection necessary: Yes No_ <br /> Does existing septic system comply with Ord . #549 : Yes No_ <br /> Unknown If no, explain: <br /> Describe septic -installation to 'be installed: <br /> 2. 1p Y t <br /> WATER SUPPLY S( _ Or, . <br /> � <br /> Is wat supplied by private well : Yes1y<110_ Is well proper: <br /> YesoI ciency: <br /> r <br /> fo'r"Pt"ose <br /> . � sroes ex ti k use make this well public Water: Yes <br /> No ample of well water taken: Yes Nom Date taken <br /> Results Additional information or comments <br /> 7)A.�2 is d L�C.' ! [.cJa S � � � ,� c�rZR4� <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Y,68--- No-- Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FLY. MOSQUTTO Oji Vr TOR P.0'r2,NTT <br /> State possible vector potential & nec control: <br /> L::L� <br /> 5 . TOILET/BATH FACILIT <br /> No . & location existing: Additional <br /> facilities needed JL/ <br /> 6. PREVTOna OPERATION HISTORY <br /> �(ap <br /> 7 . GENERAL S i9 JI-TAT ON <br /> State any problems not previously noted: <br /> 3 . POPULATION DENSTIX <br /> Appx. No. People per sq. 'mi. <br /> s / '/4 . q& ,y <br />