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t <br /> i. SRWAGE 4 <br /> Distance to .Public Sewers Connection necessary: Yes No <br /> Does existing' septic system comply- with Ord. #549: Yes Nom <br /> Unknown I f n?, explain: <br /> 4• I -- � �a ��Gr c�i ,; "f7 C •S-' S�-5 dYL- Sr�t. <br /> Describe septic installation to 'be installed: <br /> 2. HATER SUBEL`L <br /> Is wa supplied. by, private well : yes .--v/' No Is well proper: <br /> Yes No State deficiency <br /> a <br /> Does e4stin8 or porposed use make this Weil pub Water: Ye <br /> No ✓ Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & RSFOSE <br /> Licensed scavenger pick-up: Yes Noervice Area No. <br /> b <br /> Other propose disposal method: . , <br /> Potential prom: <br /> 4. ELY. MQSQUIT OR ^' R EQ'[tH2:jAL <br /> State possible vec r potential & ecessary control: <br /> 5. TOILET/BATH FACILITES <br /> No. & location existing: Additional <br /> facilities needed <br /> S. PRXVT0QS OPERATTON Hj _TQR <br /> 7. <br /> State any pro ems not previously Hated <br /> 8 . POPULATTON nRNSTTY <br /> APpx. t/leople per sq. mi. <br />