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1 . 5KWAGF <br /> Distance to Public Sewers 1 '/ Connection necessary: Yes No l��' <br /> Does existing septic system comply with Ord . $1549 : Yes No_ <br /> Unknown If no, explain) : <br /> G 7 G� <br /> / 63 /1--e . <br /> Describe septic installation to be installed: <br /> /� w,.�, u ,..✓a[).a. �Q.(�P rfi., � n.tac(z � ^�- �ea[ <br /> 2 . MATER SUPPLY <br /> Is waw 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 information or comments <br /> 3 . GARBAGE & RFFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FLY. MOSQUITO OR VFX TOR PQ'[j NTTA , <br /> State possible vector potential & necessary control: <br /> 5 . TQTLET/BATH FACTLTTFS <br /> No. & location existing: Additional <br /> facilities needed <br /> 6. pRgVTORS OPCRATION HISTORY <br /> 7 . GENERAL SANIT TA ION <br /> State any problems not previously noted: <br /> 3 . POPUL.ATION PEN SSTT`.'_ <br /> Appx. No . People per eq. mi . <br />