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J <br /> 1 • C' <br /> Distance to Public Sewers 4� Connection necessary: Yes No <br /> Does existing septic system comply with Ord. #549 : YesNom <br /> Unknown If no, explain: ���Ef�rE �qo �9✓ BEF�.�t�%41 a .� 0// <br /> �g�✓�+�.✓d /.s �Fi�G.�lirF-,%C�F.� .1••�0 t//cto�o.( .�� E .�.y��fac'c-ssi.�G d1/��✓F�/r <br /> s z s 4K' rf✓ .,r/ JE is <br /> ,ZfEO/c,��Q •/'E.�>iF •r'�.�'fF..r /�ifE.g . � �E.('„rPij'c.�',�%G� fes.( :hey° �c f� c��C , <br /> Describe septi . installation to be installed: Atm oictt <br /> ..PES < �'".y' �d•l-f� ..c ./ .GF t 6 -P / a <br /> 2 . NATER SUPPLY <br /> Is water supplied by private well : Yes No Is well pr 'per: <br /> Yes4 No State deficiency: <br /> Does existing or purposed use make this well public water: Ye <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: Yeses No Service Area No . <br /> Other proposed disposal method : <br /> Potential problem: <br /> 4 . FLY , MOSQUITO OR VECTOR POTENTIAL <br /> State possible vector potential & necessary control:,l/o-,Pl <br /> 5 . TOILET/BATH FACILITES <br /> No . & location existing : /Z/z Addit onal <br /> facilities needed �o�F <br /> 6 . PREVIOUS OPERATION HISTORY <br /> 7 . GENERAL SANITATION <br /> State any problems not previously rioted: <br /> 8 . POPULATION DENSITY <br /> Appx. No . People per sq mi , . <br />