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1 . SKWAGE Nle <br /> Distance to Public Sewers Connection necessary: Yes Nom <br /> Does existing septic system comply with Ord . 0549 : Yes No_ <br /> Unknown If no, explain : <br /> a /lackel yak, �,z kti ;amu f `# Cdr— V 9 <br /> Descr be septic installation to be instal ed: <br /> 2aa :e r? <br /> C�sbo'/def/ V6 <br /> 1encG (ut o nUaGo� =i&W x e.Lsa = v3vj�/ 0v �v"14-1 <br /> 2 . WATER SUPPL.' � $4;iluAF L <br /> Is water 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 abate taken % i> <br /> Results Additional information or comments <br /> Licensed scavenger pick-up: Yes_ No_ Service Area No . <br /> Other proposed disposal method: <br /> Potential problem:__ <br /> 4. ELY. MOSQUITO OR OR Lrj1TIA1, <br /> State possible vector potential & necessary control: <br /> 5 . TOILET/BATH f�A_ t�IL,IEi <br /> No . & location existing: Additional <br /> facilities needed <br /> 6 . PREVIOGn OPER,ATTOM HISTORY <br /> 4 <br /> 7 . GENERAL SAN TATTON NN / <br /> State any problems not previously noted : . /�Ivd<: - <br /> S . PO U ,AT ON DENSTTV ,U <br /> APpx • No . People per aq. mi . <br />