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7 7�_gsl i"#- <br /> SEWAGE <br /> ce✓S •WA E <br /> Distance to Public Sewers Connection necessary : Yes_ No—,&- <br /> Does <br /> o-Does existing septic system comply with Ord . #549 : Yes_ No_ <br /> Unknown I£ no, explain: j� j� - "/y <br /> L) .2 Thzs S .P. "7 ,2-//fig S iZo ✓ ? �/37S"zj <br /> t T A 9 7- (:v r 72.J V3 w %L 72 1-r2 q Y'7 // <br /> Describe septic installation to be installed: <br /> 2 . WATER SUPPLY <br /> Is water su plied by private well : Yes✓ No Is well proper: <br /> Yes_ No�Staie ��pficiency: T.0 a c�.,�o e � <br /> T X T i it g.4 / dY1 f '" l�4&4 erAn -A O 7`h t T <br /> r )-o � 2T 24*?7SN-/'Z-9- -�K •z <br /> Does existing or porposed use make this well public water : Yes <br /> No Sample of well water taken: Yes_ Nom Date taken <br /> Results S Additional information or comments TECs,-u i c 2/e iz a <br /> yac. a4e + ias- L �i <br /> 3 . C ARBACE & R TUSE <br /> Licensed scavenger pick-up: Yes" No_ Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FILL, MO. ITCH OR V P .NI TTp�I, <br /> State possible vector potential & necessary control: <br /> 5 . TLE.T/BATH EAC'ILITES <br /> No. & location existing : _ Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HISTORY <br /> 7 <br /> 7 . GENERAL SAN?TA�TnN <br /> State any problems not previously noted:,�_�� <br /> 3 . EOPULATIQN DEIJUTY <br /> Appx. No . People per sq. mi . - <br /> -F r G4� a1 Y e L J s J e c .A,' a S 4 G/0 J s .FX v <br /> y� � s inl fu Z/v �,.,, do� ✓iz.« �1 7 r, 2Al T- !ya'p's <br /> it/e ?✓ T Coo,,,Fs <br />