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1 . SEWAGE <br /> Distance to Public Sewers Connection necessary : Yes_ No2L <br /> Does existing septic system comply with Or #549 ; Yes_ No <br /> Unknoppn If no, expla n: PJ TEi' f'� -f3 <br /> i `- F��s�� F� �✓s�� <br /> /nkn� f iT`c� f n7�.c. 40 0.✓�..J�'.i Fri/fi 6�,t 9.�i'/f/!� i✓i/•o�C <br /> c�1iCF G�y��tlE9�e�s1/t�I .�'.-a ./F��c /'�✓1`E�r�frr.s�f�i��r/1'7�1.�F. <br /> Describe septic installation to be installed: <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well: Yes -,AL No_ Is well proper: <br /> Yes No_ State deficiency : <br /> Does existing or porposed use make this well public water: 'les <br /> Nom Sample of well water taken : Yes_ No_ Date taken <br /> Results Additional information or comments- <br /> v- <br /> 3 . <br /> omments- <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger prick-up: Yes No_ Service Area No. <br /> Other proposed disposal. method: <br /> Potential problem:- <br /> 4 . ELY . MOSQUITO OR V CTO )r2HTIAL <br /> State possible vector potential & necessary control- <br /> 5 . TOILET/BATH FAC TES <br /> No. & location exietirg: Additional <br /> facilities needed- <br /> 6 . <br /> eeded _6 . PREVIOUS OPERATTON HT,= <br /> 7 . GENERAL SAH TATTON <br /> State any problems not Previously noted: � <br /> 9 . POPULATION E,,V,,TTY <br /> Appx. No . People per eq. mi. <br />