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1 . SAGE. <br /> o-DoeDistance to Public Sewers Connection necessary: Yes No- <br /> Does <br /> s existing septic: system comply with Ord . #549 : Yes >'C No— <br /> Unknown If no, explain : <br /> Describe septic installation to be installed : <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes >r- No Is well proper: <br /> Yes. No State deficiency : <br /> Does existing or porposed use make t1lis well public water : Yes <br /> Nom_ Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method : <br /> Potential problem- <br /> 4 . <br /> roblem:4 . EjLy, MOSouj TO COY ,C �Fi_P�y' UNCI <br /> State possible vector potenti�el & necessary control : <br /> 5 , TC�TLET/BATH FACTi.T� Additional <br /> No . & location existin� : -- <br /> facilities needed -- <br /> 6 . PREV IOU GPERAT D H ar9.$Y_ <br /> 7 . GENERATE SAtil'TA'�L�13. <br /> State any problems not previously noted: — <br /> g <br /> PC)PtT1,ATION D, .NSTT-y- <br /> Appx . No . people per rcl. Mi -_ <br />