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1 . SEWAGE <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 /> KIo <br /> Describe s ptic installation to be instal,,ed: �O <br /> f� �t2 -z33 <br /> 2 . WATER SUPPLY <br /> Iser supplied by private well : Yes Ho_ Is well proper: <br /> Yes± No_ State deficiency : <br /> Does existing or porposed use make this well public water : Yes <br /> No Sample of well water taken: Yes_ No�4'- Date taken <br /> Results Additional information or comments (�)+ <br /> f 4 eI/ t✓r r vu o�c a(7 t c2 S <br /> 3 . GARRA <br /> Licensed scavenger pick-up: Yes— No_ Service Area No. <br /> Other proposed disposal method: <br /> Potential pro m: <br /> 4 . FLY MO QUITO "•T , PCfJ NTIAL <br /> State Possible ve for potentif,l & nec nary control : <br /> 5 . TOTT .T/BATHFAC Hing <br /> No . & location existing : Additional <br /> facilities needed <br /> 6 . PREVTOOS r. <br /> 7 . GENERAL SAIT-PA'ftON <br /> State any problems riot previouslyn ted: <br /> 9 . POPULATION DENSITY <br /> Appx . No . People per sq . mi . <br />