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1 . SEWGF AVArZ-�Z-�' <br /> Distance to Public Sewers Connection necessary : Yes No_ <br /> Does existing septic system comply with Ord . 11549 : Yes No_ <br /> Unknown If no, explain : <br /> Descri Pe septic installation to 'be installed: <br /> A&42t- � w,04, w fa <br /> 02 EQ a-IJ <br /> 14)111 <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes No Is well proper: <br /> Yes No State deficiency: <br /> U <br /> Does existing or porposed use make this well public water: Yes <br /> No Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> 3 . GARBA G . & REFUSF <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem,: 4f-*� otd JVaud a„d de ,-3 c+�• o���,,,,�a,�o� <br /> 4 . FLY. MOSQUTTQ QR YI_`.TOR PT.rNTIAIir- gg�SScf•PP»5s •�•c�t i+�l , <br /> State possible vector potentitil �,� necessary coAtrol: <br /> 5 . TGT LET/BATH FAC IMTS <br /> No. & location existing: Additional <br /> facilities needed <br /> 6 . PREVIOTTS O ERATTnP1 H STORY <br /> 7 . GENERN <br /> State any problems not previously noted: <br /> 4 l6 of v- /ffu.�e�1,/ a <br /> 8 . PC�PULATTc�r1 �F, ^r v <br /> Appx . No . People per eq . mi . <br />