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1 . Sr%WA iE <br /> Distance to Public Sewers Connection necessary : Yes_ Nom <br /> Does existing septic system comply with Ord . 0549 : 'les` No_ <br /> Unknown IP no, explain: <br /> /�s,II.PFGd%P.c <br /> Describe septic installatiory t¢ 'be installed: <br /> �fG✓iii i �i✓�li�, «�<.� /Eific <br /> Ike <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well: Yes Is well proper: <br /> Yes_ No_ State def-ci.,ncy: C�da <br /> Does existing or porposed use make this well public water: Yes <br /> Nom Sample of well water taken : Yee_ No - Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGR & RRBUSE <br /> Licensed scavenger pick-up: Yes— No_ Service Area No. <br /> Other proposed disposal method : <br /> Potential problem: <br /> 4 . ELY . MOSQUITO OR VECTOR POiTENTTA <br /> State possible vector potential PA necessary control : �� /f <br /> 5 . TO .ET/BATH FACTLITES <br /> No . & location existing: % Additional <br /> facilities needed <br /> 6. PRRVIOUS C BRAT ON HISTORY <br /> 7 . GENERAL SANITATION, <br /> State any problems not Previously noted: . �-✓� <br /> S . POPUfAT ON DENSITY <br /> Appx . No . People per eq . mi. tic a-4/ <br />