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l. SSG <br /> Distance to Public Sewers 42& Connection necessary: Yes No— <br /> Does exist septic system comply with Ord. #549 : Yes No— <br /> Unknown If no, explain: <br /> De crbe septic installation to 'b$ instal led: , JU l'ow! , ,_� <br /> 2. WATER SUPPLY ; <br /> Is water supplied. by private well : Yes No Is well proper: <br /> Yes No State deficiency: <br /> Does existing or porposed use make this well public Water: Yee <br /> No_.,,.::t'- Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other prrposed disposal method: <br /> Potential problem: <br /> 4. ELY. MOSGUTTO OR VECTOR POTENTIAL <br /> State possible vector potential & necessary control. _ kO °"ORL.IYA4' <br /> 40 <br /> 5 Er <br /> No. & location existing: 44OKMOW62 ''� � ``'� °OU 48W Additional <br /> facilities needed <br /> 6. PRF.yjQM CPCRATInN HISTORY <br /> 7 . GENERAL SANITAITON �adRm DR)$t r7�Rvk,41# - <br /> State any problems not previ.ou;ly noted: <br /> . r <br /> S . POPULATIQU DENaTly <br /> Appx. No. People per .i3q. mi._ <br />