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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 /> Unk� <br /> -�wn If no, explai : <br /> &-P,& s -- `g'l- 727 '- %cd.- cl �(s x: - (l�fib'Z, <br /> (7`I 3o L.,Z1fd64 $77-►oli /9!�2� <br /> 4-71-=7 S 3 (r&-t�o <br /> Describe septic installation to be installed: <br /> /y%7h0_ a4- e <br /> i <br /> 2. WATER SUPPLY <br /> Is watyer supplied by private well : Yes ✓ No Is well proper: <br /> Yes ' No State deficiency: <br /> Does eyisting 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 . GARBAGE7prob <br /> Licenseder pick-up: Yes No Servicd' Area No. <br /> Other prisposal method: <br /> Potentia : <br /> 4 . Eli�� MOSQUITO OR V , TE i'[ENTIA , <br /> State possible vecto patentittl & nece ary control : <br /> 5 . TOTT,,ET/BATH FACILITES <br /> No. & location existing: Additional <br /> facilities needed _ <br /> 6 . PREVIOUS OPERATION HISTf�X <br /> i <br /> 7 . GENERAL SAPITTA`1'ION <br /> State any problems not previously noted:_ � <br /> 8 . POPULATION DEi <br /> Appx. No . People per 6q. mi . <br />