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Distance to Public Sewers r�^Ikconnection necessary: Yes No!✓ <br /> Does existing septic system comply with Ord. #549 : Yes ✓ No_ <br /> Unknown If no, explain: 86 t <br /> Describe septic installation to 'be installed: <br /> dial �„� --�-�,,o,�„�-f-h„r �wL�4c: (�J a-�-t.•- <br /> 2. WATER SUPPLY P-eSId,t0%C4, �nve � ✓ also <br /> Is wat r supplied by private well Yes ��o Is well proper: <br /> Yes VNo State deficiency: <br /> Does xisting or porposed use make this well pudic water: Yes <br /> No-=-- Sample of gall water taken: Yes No Date taken <br /> Results Additional information or comments <br /> �rr� ..tz •^- wGII vw ��ceiL.. .�.vwaa.�o�.,t�.� q.cc,./. ►® L �ea.�ed . Zs <br /> e � i.- CGW4 its-e4e-w5 fTjT*'a- <br /> .S'f-ct i G� <br /> 3 . GARBAGE & .$F A►t <br /> Licenced scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. FLY, MQSQULTQ OR YEGME-220WITAL <br /> State possible vector potential & necessary control- <br /> 5 . TOILET/BATHEACTLIxE, �. Additional <br /> No. & location existing: <br /> facilities needed <br /> 6. PREVTOUS QEERAIIQU HTSTORX <br /> 7. GENERAL 5AITI.TATIO <br /> State any problems not previously noted: <br /> 3 . MULATTO ally <br /> Appx. No . People per sq. mi. <br />