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1. SEV�AGE <br /> Distance to Public Sewers N Connection necessary: Yes No <br /> Does existing septic system comply with Ord. #549: Yes No <br /> U k�.t a�•✓►t r1 v Seo 7'Z c 3QUL --V'r• s o^r. l e <br /> Describe septic installation to be installed-. Na"`4 a+ - iu tra`�r <br /> 2. WATER SUPPLY C1 <br /> Is water supplied by private well: Yes ✓ No Is well proper; Yes `�No <br /> State deficiency: +J _A — <br /> k <br /> Does existing or proposed use ma a this well public water: Yes No `�Sa ple of well <br /> water taken: Yes No Date taken ��' Results n� �} <br /> Additional information or comments: <br /> 3. GAGE & REFUSE / <br /> Licensed scavenger pick-up: Yes ✓ No Service Area No. (24zl w <br /> Other proposed disposal method: <br /> ..,. Potential Problems: <br /> 4. FLY, MOSQUITO, OR VECTOR POTENTIAL <br /> State possible vector potential & necessary control: <br /> k <br /> 5. TOILET/BATH FACILITIES <br /> No. & location existing: <br /> Additional facilities needed <br /> 6. PREVIOUS OPERATION HISTORY <br /> S c .•CAI( I o-F C w vv�. c�sed a S a o v u(�•d <br /> 7. GENERAL SANITATION N d <br /> State any problems not previously noted. <br /> 8. POPULATION DENSITY <br /> Appx. number of people per square mile <br /> f <br />