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1 . SEWAGE <br /> Distance to Public Sewers Connection necessary : Yes_ No_ <br /> Does existing septic system comply with Ord . $1549 : Yes_ No_ <br /> Unknown If no, explain: <br /> Describe septic installation to be installed: <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes _ No_ Is well proper: <br /> Yes— No_ State deficiency: <br /> Does existing or porposed use make tliis well public water : Yee <br /> No Sample of well water taken: Yes_ No_ Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & R .F 1S . <br /> Licensed scavenger pick-up: Yes_ No_ Service Area No . <br /> Other proposed dispo�ggaI method: <br /> Potentia] roblem:yiVJ "'LJ' ,,a405K <br /> 4. FLY. MOSQUITO OR VECT�_OR Pi'j'J;NTIAL'�� <br /> State possible vector potentif,l & necessary control : y��< <br /> 5 . TOILET/BATH FACTTTTES <br /> No . & location existing : Additional <br /> facilities needed <br /> 6 . PREM ns OpggATION HISTngy <br /> 7 . GENERAL SAIIIATION <br /> State any problems not previously noted: -0240' E <br /> 9 . PnpU .ATTnN pFiI,,ITy <br /> Appx . No . People per sq . r.,i.- .f�/�y��LE—.Pfli�F✓�.91 <br />