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1 . SF1.AG <br /> Distance to Public Sewers ir;l Connection necessary: Yes No-- <br /> Does <br /> o=Does existing septic system comply with Ord . #549 : Yes_x:_ 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 ><- No Is crell proper: <br /> Yes No State def�ci..ncy <br /> ����,L; ,�,' � .�%�r',sf.✓E�./41F�! �,� 1fi.►f of.DE�.C".��..�a'�-.>J'' <br /> �a��E.G /� �✓!e1 .�E�<<�.6.G, �//�.fir/ '��2�P`,1' e/E.���.,���'e�,� <br /> Does existing or porposed use make tliis well public water: Yes <br /> No__-',, _ 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 /> Vii. �_ -.-,. ;,�v,•. .• .;� ��.+r.s`.,p1+ss ..pN'�ic�i�1G'�..r.,fyr:�,,.:�",�^;tN,. <br /> 4 . F. y. MOSQUITO OR Vri:^.TOR PO'[ENTTAL�a�crE �,��.r,�� �o�c���a��e•�,/��f����' <br /> State possible vector potentiftl & necessary control: -s:•%c <br /> 5 . VILE /BATH FACILITES <br /> No . ek location existing: ,-,., _ __ Additional <br /> facilities needed - <br /> 6 . PRFVIQnS OPPERATICN HISTORY <br /> 7 . GENERAL SAMIArTON <br /> State any problems not previously noted: <br /> 8 . POPULATION DENSTTX <br /> Appx. No . People per eq. mi. <br />