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1 . SRWAGH <br /> Distance to Public Sewers t4*Wc"O Connection necessary: Yes_ Nom <br /> Does existing septic system comply with Ord . 0549 : Yes Y No_ <br /> Unknown If no, explain: <br /> Describe septic installation to 'be installed: jo S,J.eo Cade <br /> i Bu.1jou� 5, Mr-- AN!-, I)4 aof13EK o� PCoP <br /> 2. WATER SUPPLY <br /> Is water supplied by private well : Yes t' ►-jo 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 Na Date taken <br /> Results_ Additional information or comments &411 nl usF,.s uuKnxxw <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenaer pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem- <br /> 4. <br /> roblem:4. FLX. MOSOUTTO OR V OR POTENTIAL <br /> State possible vector potentirtl & necessary control: <br /> 5 . TOTLET/BATH ,FACT_LTTE5 <br /> No. & location existing: Additional <br /> facilities needed <br /> 6. PREVTOna OPERATION HZcSJQRY <br /> �C t tl PMEN� 5�cis r ✓��� tii f(61, <br /> 7 . rjENERAL SANTTAITON <br /> State any problems not. previously noted: <br /> 9 . POPULATION DENSTTY <br /> APpx . No . People per eq. mi. <br />