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1. SEWAGF, <br /> Distance to Public Sewers N Connection necessary: Yes No <br /> Does existing septic system comply with Ord. ##549 : Yes 'yNo— <br /> Unknown If no, explain: <br /> Describe se tic installation to 'be installed: &Y VA,4e . <br /> 2. WATER SUPPLY <br /> Is Water supplied. by private well : Yes � i10Is viell proper: <br /> Yee No ✓State deficiency: G�1 <br /> 04d, y691 <br /> Does ting or porposed use make this well public Water: Yes <br /> No Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> 3 . CABBAGE .. REFUSE <br /> Licenaed scavenger pick-up: Yes �No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem:-- ._ <br /> ,4 . FLY, MQ3091TO OR VEQTQR POTENTIAL <br /> State possible vector pvtentittl 9z necessary control: <br /> 5 . ZnILETZHATH EACI rTES /L//IA. <br /> No. & location exictins : . _��. -_ ..�.,, Additional <br /> facilities needed <br /> 6. PREVIOUS OPERATI011 HISTORY <br /> Sri) ` ar <br /> 7. GENEBAL 5AUTTATIQU /?veyy <br /> State any problems not previously noted: <br /> 3 . BQP LATT!2H nFk0TTv A/J4 <br /> Appx. No. People per aq. mi. <br />