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��-cjsz-H' (,J(-{� �.6� ,•.�al �'f,s ��Q�s'fl�.�z-.c Nf`'� ,5,-/Z1i-, ,7. <br /> / J , <br /> SEWAGE <br /> i . <br /> Distance to Public Sewers !," ' Connection necessary: Yes Nom <br /> Does existing septic system comply with Ord. $1549 : Yes No_ <br /> Unknown If no, explain: <br /> r <br /> `j✓�=t��- cG�: ,,-rr� -4y nuc t� Lam`-�-4 c,'�..�'r-z� <br /> Describe septic in to 'be installed: <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes No Is well proper: <br /> Yes No State deficiency : <br /> Does existing or porposed use make this well public water: Yes <br /> NoSample of well water taken: Yes No Date taken <br /> Re ults Additional information or comments <br /> o be <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal me 4od: <br /> Potential problem: c. <br /> 4 . ELYL MOSQUITO 0}3 VE^TQC ZC)f T <br /> State- possible vector potentiftl & necessary control: <br /> 5 . TQ ET/BATH FACILITES) <br /> No. & location existing : Additional <br /> facilities needed _ <br /> 6 . PREVIOT72 OP FATIIQU HI STCl + <br /> ( �r S`K-y '�.i:� —�L�-. c r �u C�,�:li,,,s� F� �•t. .S"fZ t..c..I+/.J /v'h'f <br /> 7 . GENERAL SANITATION <br /> State any roblems not prevlously noted: <br /> i <br /> 8 . POPULATION DENSTIY <br /> Appx. No . People per Bq . mi . <br />