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I r 7 .11 7:2-6.? a -7 S 'r <br /> Distance to Public Sewers Connection necessary: Yea No— <br /> Does existing septic system comply with Ord. #549 : Yee No_.,. <br /> Unknown If no. explain: <br /> Describe septic installation to 'be installed: <br /> �J r�3f� �1iYyr /` 7a-- F9 ✓ 4 } C�aT �`.rs� _ ga-�dS- <br /> 2. SEATER SUEPLY <br /> Is water suppliedby private well : Yes 'No Is well proper: <br /> Yes No State deficiency: <br /> Does existing or porposed use make this well public crater: Yes <br /> No Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> 3 . <br /> Licensed scavenger pick--up: Yee Service Area No. <br /> Other proposed disposal metho <br /> Potential problem: <br /> ell <br /> 4. FLY, MOS!QUITQ QJR YEQj0�_ R PO' ,,NTIAL <br /> State possible vector potential & necessary control: <br /> 5. TnILET/HATH FAQILTTF. <br /> No. & location existing:. -- ._. _ Additional <br /> facilities needed <br /> 6. OL"ITOnS OPERATTOM <br /> ,2=9.:e aL2 Ale k--a --Lim—L-4-10 <br /> r <br /> 00, <br /> 7 . <br /> T . UENERAL 5ANTjAjTQM <br /> State any problems not prevlouw <br /> S . Pt}PCILATI0t4 DFtLdSITy <br /> Appx. No . People per sq. iii . � , <br />