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r <br /> 1 . SEIIA.QE <br /> Distance to Public Sewers Connection necessary: Yes � <br /> No_ <br /> Does existing septic system comply with Ord. #545 : Yes._„ No_. <br /> Unknown If no, explain: <br /> Describe 0eptic installation to 'be installed: rGcv.�Y� <br /> 2. WATER SaEP11Y <br /> Is Hater supplied. by private well : Yes �., iao Is well proper: <br /> Yes-2:51. too - State deficiency: <br /> Doe existing or porposed use make this well public Water: Yes <br /> No Sample of well water taken: Yes No Date taken <br /> Results`. Additional information or comments <br /> ' k <br /> 3 . GARBAGE & REEUSE <br /> Licensed scavenger pick-up: Yeses No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. ELY L. MOSO I„T.Q,4.13 VE010 PCTE,NTIAL <br /> State possible vector potential & necessary control: <br /> 5 . TOURTZIA211 FACTLITES <br /> No. & location existing: Additional <br /> facilities needed <br /> S. PRR_YIOnS GPERA ,InN HISTnRY <br /> i <br /> ?. GENERAI, SAITTTAITQtji <br /> State any problems not previously noted: <br /> 9 <br /> $ . 20PULATION DRUSTIJV <br /> Apex. No. People per .sq. mi. . . ..,.,.-.. .,,.__.... :, <br />