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1 . SEWAGE <br /> Distance to Public Sewers ' Connection necessary: Yes No <br /> Does existing septic system comply with Ord . #549 : Yes -•; _ No� <br /> Unknown If no, explain: <br /> Describe seplqf ina al t F; to be installed: <br /> .11 9c V' <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes� /�/ No s well rer: <br /> Yes No W_ State deficiency : ry2y �-�� - � .Go� <br /> Does existing or porposed use make this well public water: Yes- <br /> No X' <br /> esNoXSample of well water tarsen: Yes No---:!�,. DatWako <br /> Results Additional information or comments -41 <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes. No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FAL MOSQU LTn QRyE^TOS PC'fTdJTIAj1.L <br /> State possible vector potentiftl ez necessary control:��t` <br /> 5 . TOILET/BATH FACILITES <br /> No . & location exiting: Additional <br /> facilities needed _ <br /> 6. PREVIOnS OPERATION HISTORY- <br /> 7 . <br /> ISTORY7 . GENERAL SANITA7.' -(_) <br /> State any problem.- not previously noted : <br /> S . R0PUf,6TjQj4 DEd,,ITY <br /> Appx. No . People per oq . r;, i . �61��10'� �= ��4s''DEi✓ �'� <br />