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Distance to Public Sewers A) IA_ Connection necessary: Yes No-K <br /> Does existing septic system comply with Ord. #549 : Yes= No_ <br /> Unknown If no, explain: <br /> fe,,, ,4 * 99-- /072- 7/–//2o <br /> Describe septic installation to be installed: <br /> /V rn <br /> 2. WATFR�fTPPi,`/ <br /> Is wat supplied by privates well : Yes � ido_ Is well proper: <br /> Yes_ No_ State deficiency:— <br /> Does. , fisting or porposed use make this well pub is Hater: Yes— <br /> No— <br /> esNo Sample of well water taken: Yes_ No_ Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGF. & RFF IS . <br /> Licensed ecaven er pick-up: Yes_ NoSer vice Area No. <br /> Other proposed d poral method: <br /> Potential problem! <br /> 4 . ZLLY. MOSbUITO OR vr,��nn Pn,pr[JTTp� <br /> State possible vecto potential & eceseary control : <br /> 5. TOILET/BATA FACTLTTES <br /> No. & location existing: Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HISTORY <br /> 7 . G •N .RA . ANIT 1A 'ION <br /> State any problems not Xreviously noted\--7- <br /> 8 . <br /> POPULATIO14 nENSTTY <br /> Appx. No. People per n, mi . <br />