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9- <br /> 1 . SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes No.X <br /> Does existing septic system comply with Ord . #549 : Yes No_. <br /> Unknown Iff no, explain: <br /> /��'E ��t/O _ �pC/E,.��e� C�s�1�l�C �sI f✓,mac f �l ' <br /> D seri a sep c_xnstal atii n to be instal led <br /> 2 . WATER SUPPLT1 <br /> Is water supplied by private well: Ye No s w 1 rope,--.Yes No State cleficiency :�c`��� �a'''>� r ��'` <br /> Does existing or porposed use make this well public water: Yes <br /> No­,�'- Sample of well water taken: Yes Date aken <br /> Results Additional information or comments� ��`-C ®�. <br /> 3 . GARBAGE. & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . I`LL MOSGrU i Tp OR V2,T ) ' )rLEII 1u <br /> State possible vector potential & necessary control :.�'� - <br /> 5 . TOTI ET/BATH FACILITES `` � � <br /> N o. Fc <br /> location existing: �/i`�,�%/ �•�f%�7fit /.!�'6 Additional <br /> facilities needed <br /> 6 . PRFVTOUS OPERATION HISTO , <br /> 7 . GENERAL SANT `1TA 'IQjJ ,`, r <br /> State any pro blems riot Previously noted : <br /> 3 . popULATT014 DENSITY <br /> Apex. No . People per <br />