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k r <br /> f <br /> 1 <br /> S <br /> L <br /> f 1. SEWAGE <br /> i <br /> Distance to Public Sewers Connection necessary: Yes No <br /> Does existing septic system comply with Ord, #549: Yes No <br /> r..�1vW,n. 010♦ �riw.>.� �-� a f+e.T { r�5f a�w_ S;� , <br /> Describe septic installation to be installed: <br /> a .-d C <br /> 2. WATER.SUPPLY <br /> Is water supplied by private well: Yes -- No Is well proper: Yes No <br /> State deficiency: t rLQ+- ,s , <br /> or <br /> Does existingropbsed se make this well public water: Yes L--�No Sample of well <br /> water taken: Yes No ,/bate taken ►J A Results_ A)JA- <br /> Additional information or comments: <br /> 3. GARAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potentia! problems: <br /> 4. FLY MOS UITO. OR VECTOR POTENTIAL <br /> State possible vector potential & necessary control: { <br /> s 5. TO FACILITIES <br /> No. & location existing: <br /> Additional facilities needed <br /> 6. PREVIOUS OPERATION HISTORY <br /> Ca <br /> 7. GENERAL SANITATION <br /> State any problems not previously noted.- <br /> 8. <br /> oted:8. POPULATION DENSITY <br /> Appx. number of people per square mile <br />