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SKWAGR <br /> Distance to Public Sewers Connection necessary : Yes_ No_ <br /> Does existing septic system comply with Ord , $$549 : Yes_ No <br /> Unknown If no, explain: <br /> Describe septic installation to be installed: <br /> 2. WATER SUPPT, <br /> Is water supplied by private well : Yes —b'f No_ Is well proper: <br /> Yes-&Zllo_ State deficiency: �- <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---.r <br /> � e <br /> 5 'No <br /> 3 . <br /> Licensed scavenger p ck up. es� o� ervice Area No. <br /> Other proposed dispos 1 method: <br /> Potential problem: Al Qz:;2aj /I <br /> 4. FLY . MOS©UTTO OR V ECTOR <br /> State possible vector potential & necessary control: <br /> 5 . TOILET/BATH EA('ILITES � � <br /> No. & location exiting: Additional <br /> f&CLLUZics needed '2 r<7 <br /> Z 1A <br /> 6. PREVIOUS OPRRATTON HISTORY ) l �� s 7-.e <br /> 7 . GENERA . SAN TATTON <br /> State any problems not previously noted: <br /> 3 . POPULATTON DENSTTY <br /> Appx . No . People per s4 • mi. <br /> p'0 CLn c� e-y q row ,� y a 6 t Xs <br /> /V 'q N� � s.� - /� , 7SC/ � <br /> �-- L ? ?& 3 <br />