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SEWAG <br /> I . CJS .�T= <br /> Distance to Public Sewers Connection necessary : Yes No, <br /> Does existing septic system comply with Ord . #549 : Yes No <br /> Unknown If no, explain: 16a05'Q-74-,4 <br /> 7c- <br /> 0"A <br /> - - - ,Z- r/�acL li AXA: vvH /-L1 7g <br /> 0" 6:L' <br /> Describe septic instal ation to *be installed: t <br /> i� ee <br /> ' i.. lev <br /> �Q s e <br /> 2 . WATER SUPPLY / <br /> Is water supplied by private well : Yes No 'SIE well proper: <br /> YesNo State deficiency : <br /> Does existing or porposed use make this well public crater: Yes <br /> No Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> g , GARBAGE & REFUSE <br /> Licensed scavenger P:,_ck-up: Yes No Sery ce Area No. <br /> Other proposed disposal. metho <br /> Potential problem: <br /> ­ <br /> 4 . FLY. MQSnUITO QR V=O—E—E2 <br /> State possible vector potential ne ssary control: <br /> 5 . TOILET/BATH FACILITES <br /> No. & location existing: Additional <br /> facilities needed <br /> 6 . PREVTOnS OPERATION n <br /> 7 . QENERAL SANT. TAT N_ <br /> State any problems /hot previously noted : <br /> 3 . POPULATION DRM,� Y <br /> Appx . No . People per a=1 . mi. -- <br />