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Distance to Public Sewers M«mss / <br /> Does existing septic system comClnr1witho�iOrdCe#549Y yes No <br /> Unknown If no, explain: p y No_ <br /> j 9:--7— 2-33/ 3zs�s s. Kuss - <br /> Describe septic installation to be installed: <br /> 2. WATER S )PPT `� <br /> Is wat r supplied by private well : Yes —Zi10 Is well <br /> Yes V No State deficiency: proper: <br /> Does e,Aisting or porposed use make this well pubkic Water; Yes <br /> No ✓ Sample of well water -taken: Yes No ✓ Date taken <br /> Results Additional information or comments <br /> We -av 5 411 jo <br /> 3 . GARBAGE & REFUSE <br /> . Licensed scavenger pick-up: Yes No Service Area No. <br /> 0 er proposed disposes method: <br /> Pote tial problem: <br /> 4. F TTO OR 'g ) P <br /> State poss ie vector potential & necessary control: <br /> i <br /> 5 . <br /> (' i <br /> No. & location existing. � _ Additional <br /> facilities needed <br /> 6. PREVIOUS OPERATION HISTORY\XZ <br /> 7. GENERAL SANI'�TI M <br /> State any probler not previously noted: <br /> 8 . POPULA OtVDIENSITY <br /> Appx. No. People per sq. mi. <br />