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1 . SKWAGE <br /> Distance to Public Sewers ^� Connection necessary: Yes No=, <br /> Does existing septic system comply with Ord . 11549 : Yes ✓ No_ <br /> Unknown If no, explain: <br /> It // V 4 z 2/1-/9-z - /1.7q � <br /> 7Q - �z.SL 6 d Cy R.`✓, `I O- 311 '717 G <br /> Describe septic installation to 'be installed: <br /> To 1-R st z-c a a fie ; o-f acco.-ol i *o �aon)c • 36� <br /> e-w�(E S c_ c .� 6/aQ c �o r v e S �y.� S r 'Le--i ot*t <br /> 2 . WATER S flPPLY <br /> Is water supplied by private well : Yes � No Is well proper: <br /> Yee � No State deficiency : <br /> Ey l S-h as, cam. <br /> Does e fisting 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 /> - <br /> -/ o u S-c Z X d f i•� litre CL o/o{ u,2!/ c c 9 i <br /> .1'Ga �( .Le. oCe sfivv�e cl . <br /> 3 . GARBACa : & ER IS <br /> Licenced scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem:_._._ <br /> 4 . FLY, MOSQUITO .,•QE–yrZT-0-2-PS!?I ILTJAL <br /> State possible vector potentictl +.c necessary control: <br /> 5 . TO I LETIBATB <br /> No . & locution existing : Additional <br /> facilities needed— - ---- <br /> 6 . PREVTO05 Q jLZ CRY <br /> 7 . G .N .RATSS�,8N12:ATIC)N <br /> State any pro't-)lems not Previously noted: <br /> 8 . POE 1 .A T jC?�.. DF'.,,-T v <br /> Apex . No . Peopi.e per sq. Mil . <br />