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Ne sT <br /> 1 . SEWAGE <br /> Distance to Public Sewers Connection necessary: Yea No_ <br /> Does existing septic system comply with Ord. 0549 : Yea No_ <br /> Unknown If no, explain : <br /> Describe septic installation to 'be installed: <br /> d 7 / r 7CS <br /> at,.� PS odk2 i� a c.:.: 5�`PA�lfx S y5 ✓ itw�/r lir. <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes No Is well proper: <br /> Yes <br /> ^ No State deficiency : <br /> 1, 'eeu �i ✓leu. �,= r( /i u,�, e o .iw.- <br /> T <br /> Does existing or porposed use make this well public water: Yeses_ <br /> No Sample of well water taken: Yes Nom Date taken <br /> Results Additional <br /> information or comments <br /> JvVOkS� ai — % l 7/' Ala,,— PJ, L/ <br /> -'36�i}t �.O� �1!/0�►dyr <br /> 3 . GARBAGE & RF.FUSF. / <br /> Licensed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposa� method: <br /> Potential - <br /> r <br /> 4. FLY. _MOSQUITQ o.�v MIC-1 MMEMI.L <br /> State possible vector potentiftl SA necessary control : <br /> 5 . TQILET/BATH FACILITES <br /> No . & location existing : Additional <br /> facilities needed _ <br /> 6 . PREVIOr12 OPERATION HIS'fnFtY <br /> ,. ,, -d <br /> 7 . GENERAL SA14 T `l_A ION, <br /> State any problems. not previously noted .- - <br /> 8 . <br /> oted :8 . POPULATION DFij.,ITy <br /> Appx . No . People per r-.c: . r,i . <br />