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y <br /> 1 . SEWAGE <br /> Distance to Public Sewers -y"L- Connection necessary : Yes No , <br /> Does existing septic system comply with Ord . #549 : Yeses No_ <br /> Unknown If no, explain ! <br /> Describe/ septic installation to be iristalled: <br /> ,.,�1.� ./,,U.;,• .,�-.✓ � �--� - •• .,� ?,• �... j <br /> 2 . MATER SUPPLE <br /> Is water szpplied by private well : Y s No Is well pyoper: <br /> Yes No,Z State -def icie.ncy .:�7�-�E�T� -�aaf <br /> .0 /t/��i QQ��/f/�ir//Ofdilii�/1�///�F9 Gif 97!c e c.t .li c�dE�i 4/�ffc �v�Biid!/utir'/'lea� F., u�fle <br /> /lFc�O 7J ./T/�.L,l fJ l�F✓ 9 G ���1,(� : <- �'9fi��9�y�y✓�',t���'E�`7� �t/�/✓,?:.mss//'-z <br /> Does existing 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 /> Licensed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: �4 . =L - MQSGUI EQ OR _Y OTO • T� NSI�1L� <br /> .State possible vector potenti�-il necessary control : <br /> 5 . TQILFT/BATH FACILI'1TS <br /> No . & location existing ., -/,"'' Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION H== <br /> 7 . GENERAL SANI" T t <br /> State any problems not previot sl; , notec:l: _ <br /> 8 . POPUL TIQN DEN-3=11 <br /> Apex . No . People per sq. <br />