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1 . SKWAGK <br /> Distance to Public Sewers f Connection necessary: Yes — <br /> 'No-Does existing septic system comply with Ord . #549 : Yes No_ <br /> Unknown Ii no, explain : 7K69-s2 <br /> .25"'fA,� N�f f Cru•dt.�st� - #(,q-3y3 <br /> .1.0 �K o'w.r_ G.•vw.. fs q-� - <br /> Describe septic installation to be installed <br /> /3 D rte/E <br /> 2 . WATER SUPPLY �"f rN`�° <br /> Is war supplied by private well : Yes L No_ Is well proper: <br /> Yes_ No_ State deficiency : <br /> Does existing or porposed use make this well public water: Ye <br /> No�. Sample of well water taken: Yee_ No ✓ Date taken <br /> Results Additional information or comments <br /> � ) <br /> No <br /> L <br /> 3 , GARBAGj—&-`RBFUSS <br /> Licensed scavenger pick-up: Yes_ No_ Service Area No. <br /> Other proposed disposal method: <br /> Potential problem:__ <br /> 4. _FLY , MOSQUITO ORVr^TOR POTENTIAL <br /> State possible vector potentirti & necessary control: <br /> 5 . TOILET/BATH FACILITES <br /> No . & location existing : A Additional <br /> facilities needed <br /> 6 . PRRVIORR nPRRATIOt. HIRTnRY <br /> 7 . GF.N .RA . SANITATTos <br /> State any problems not previously noted: <br /> 9 . POPULATION DrNSITY <br /> APpx. No . People per aq . ml . <br />