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•J ..,i..,�. <br /> 1' SE11AGEtf Connection necessary: Yes f <br /> Distance to Public Sewers <br /> Does existing septic system comply with Ord. #549 : Yes No_ <br /> Unknown If no, explain: <br /> Describe septic insta3,lation to 'be installed: <br /> Q. <br /> 2 . WhIE_R .SUPPL`I <br /> Is wa r supplied by private well: Yes � No Is well proper: <br /> Yes No State deficiency: <br /> Doe ,isting or porposed use make this well pub c dater:, Yes <br /> No . Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> Gf efl os1-e. 1` Z7111 / 2-7�y r <br /> 3 . GARBAGE & REFUSE <br /> Licenced scavenger pick-up: .Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potentialoblem: <br /> 4 . �EVEENTIAL <br /> State possible eetar pGtentiftl necessary control: <br /> 5 FACILITES / <br /> i€ No. & location existing: Additional <br /> facilities needed _ <br /> 6 . BREVIQUS OPERATTON HIgTZ. <br /> f <br />� f <br />` 7 . GENERAL SANT `ice '1` )2 <br /> State any problem~ not previously rioted: <br /> 8 . EOPULATT014 DENN `'{,CITY <br /> Appx. No . `People per ,f3q. mi . <br />