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s <br /> I • $EWAQaFi <br /> Distance to Public Sewers �_ Connection necessary : Yes No-.L- .' <br /> Does existing septic system comply with Ord . #549 : Yes No_ <br /> Unknown If no, explain: IJz�v,-- <br /> Describe septic installation to be installed: <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes No Is well proper: <br /> Yee No— State deficiency : 5+UT,+ 04R&A-)14 <br /> Does e isting 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 /> 3 . GARBAGE & REFUSE <br /> Licenaed scavenger pick-up: Yes No ✓ Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . ELY. M SQUITQ QR VEQTOR P.,Oi'rENTIAL <br /> State possible vector potentiFtl & necessary control: uN4Qze- 7"n <br /> 5 . TOTLET/BATH IaACILITES <br /> No. & location existing: Additional <br /> facilities needed <br /> 6 . PREVIOUS n BRAT oN HISTngX <br /> 7 . GENERAL SANITATION <br /> State any problems not previously noted: TM's G r,�lg capr� <br /> � a Ref L A RUE #J liv"/I 3/Te m t K ite-r- <br /> 8 . ROPULATTON PE NaTlY ��KF <br /> Appx. No . People per aq. mi. <br />