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o- <br /> w. <br /> y n <br /> F• <br /> 1 <br /> Distance to - ublic Sewers Connection necessary: Yee No_�' <br /> Does existiniP septic system comply with Ord. #1549 : Yes No_ <br /> Unknown If no, explain: <br /> Describe septic installation to 'be installed- <br /> 2. <br /> nstalled:2, WATER S[I1_'PLY � --e epl 1> . ab <br /> Is water supplied. y private well: Yes Na' Is well proper: <br /> Yes No State deficiency: <br /> Does existing or porposed use make this well public water: Yes <br /> No Sample of well water taken: Yes No. i bate taken. <br /> Results Additional information or comments <br /> 3 . GARBAGE & RRFUSE <br /> Licenced scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: - <br /> 4. FI,X. MQ5.4.jjQ OR yr.,QTnit Po,rcNTj,& <br /> State possible vector potential & necessary control: <br /> 5. <br /> No. & location existing: Additional <br /> facilities needed <br /> 6 . EREVIOUS OPERATION n <br /> { <br /> 7. GENERAL SANTTATION <br /> State any problems not previously <br /> j <br /> a . P01 LjjjAjjQH DRNSTTY <br /> Appx. No. People per act. mi. <br />