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l gRWAGF <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 /> ®l/a P Kis� , ,� Se-L"f-r c s'yskv✓`-' <br /> Describe septic installation to 'be installed: Lx' c` <br /> C-V Se"-ev . gyp <br /> ys <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 this well puic eater: les <br /> No Sample of well water taken: Yes_ Pio Date taken L' <br /> Results Additional information or comments <br /> Ai1�u,-u Z 7�z <br /> 3 . GARRA . . & RRFUSF pu , co,�orDfu <br /> Licensed scavenger pick-up: Yes` No Service Area No . <br /> Other proposed disposal method: ti r <br /> Potential problem: A ; <br /> 4 . FLY. MOSAUTTO OR VF^.TnR p )'f :NTTA , <br /> State possible vector potential & necessary control : <br /> 5 . TOILET/BATH FACTT,ITF.S <br /> No . & location exis ting: Additional <br /> facilities needed 'J n.-e <br /> 6 . PRFVTOns opRRATTnN HTSTORY <br /> c <br /> 7 . GENFRAT, ^ANI TATTOO <br /> State any problems not previously noted : <br /> 3 . P0P11i,AT T nt7 L,Ft;STTY <br /> Appx. No . People per sfl . mi . /yec/ k , - 4 rv� <br /> 'v✓ C t �Q r2 e� <br />