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r - <br /> r S]EWAGR <br /> Distance to 'Public Sewers /` Connection necessary! Yes=No_ <br /> Does existing septic system comply with Ord. #549 : Yes No.,_._ <br /> Unknosin 'If no, explain: <br /> -75- F33 / f.7-2.17 <br /> 1248 w• �6l..a�•{- .. l��. -(p . � YR_x�s' � �` Y3 <br /> Describe septic installation to 'be installed: <br /> Z. WATER SUPPLY <br /> Is wasupplied. by private well: Yes '�Nlo Is well proper: <br /> Yes No State deficiency: „ <br /> Doesexisting or porposed use make this well puWater: Yep <br /> No Sample of well water taken: Yes No hate taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem- <br /> 4. <br /> roblem:4. FLX, MOSQUT10 OR VZ". nR PUrENTIAL <br /> State possible vector potential necessary control: <br /> 5 . TnILET/BATH FACIL,ITEa <br /> No. & location existing: Additional <br /> facilities needed <br /> 6. PRRVTOnS OPERAT19H HTSTORX <br /> I <br /> 7 . rzENERAL SAITTIATIQH <br /> State any problems not preciously noted: <br /> 8 . EQPULATTO14 DEYSYTv <br /> Appx. No. People per .aq. mi . <br /> k <br />