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1 . SEWAGN <br /> Distance to Public Sewers Connection necessary: YesNo_t::� <br /> Does existing septic system comply with Ord. #549 : Yes- No_ <br /> Unknown IE no, explain: <br /> o2�C/0',CB <br /> Describe septic installation to be installed: <br /> p <br /> 2. WATER SUPPLY <br /> Is water suyiSlied by private well: Yes No_ Is well proper: <br /> Yes_ No ✓_ State deficiency: <br /> 1 an c al s iKd <br /> z ofd <br /> Does elstincess yy11��ti . <br /> g or pofposed 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 /> -t)Lp e)ct&-h C4 c,,.e 11 Sia// 6 e dr s-No,.cd a /4- well �kall 6e-, <br /> 3 . GARRAGE & REFUSE C'oh--tn<c*d qaI W&ak <br /> Licensed scavenger pick-up: Yes No_ Service rea No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. FLY, MOSAUTTO OR VE^ O P <br /> State possible vecto potential & necessary control: <br /> 5. TOILET/BATH FACILITES <br /> No. & location existing: Additional <br /> facilities needed <br /> 6. PREVTORS OPERATTOM HISTORY <br /> co_ - 9 <br /> 7. GENERAL SANITATION <br /> State any problemsno previously noted: <br /> S . POPTIT.ATT014 DENSv <br /> Appx. No. People per sq. mi. <br />