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i . SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes_ No, <br /> Does existing septic system comply with Ord . #549 : Yes— No_ <br /> Unknown—4- :no, explain: <br /> Y� '9��4/7�(C6ia�fi4r/ <br /> �/ GO��i¢ G/..crPf lFiyiefe / ..lam/I.�i%� •IEffic ��7'+i.. .ie!?�F <br /> Desc i septic installation to be installed <br /> ¢ �y� <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 public water: Yes <br /> No Sample of: well water taken: Yes_ No_ Date taken <br /> Results Additional !1gforiq t n or com�jenys <br /> ��f�.d� t�r�-F� c✓'fE.� 1/.u�d 7fr�fs � 9 add`%� 4/��zl�^;, <br /> 3 . GARBAGE & REFUSE <br /> df / S�9faf/���= �.✓ o�F . <br /> Licensed scavenger pick p: Yes_ NO- .Service Area No . <br /> Other proposed disposal method: <br /> Potential problem : <br /> 4 . FLY MOSQUITO OF V21MilE�ip} N_ � <br /> State possible veet93r potential ,& necessary �ntrol -�s�✓F� <br /> ted. ,tees ���/E Lid��ciC7K � ��7✓ Bir-W/ <br /> 5 . TQILET/BATH FACILITES ��,/ <br /> No. & location existing : 4Additional <br /> facilities needed__ <br /> 6 . PREVIOUS OPERATION HISTORY <br /> 7 . GENERAL SANITATION <br /> State any problems riot previously rioted: �6�/a�✓/ �.Jl�s�✓.vrf�[�f <br /> �tsf�.lye -'i<tes ilf/�•�JE �/i(.lfj6f ,dfite.Ci%is.v �.yd.o/iTert. �.C�A4y� <br /> S . POPULATION DENST.0 / <br /> Appx . No . People per sq. mi . <br />