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1 . AG <br /> Distanc,�; to Public Sewers Conn ec-1Cii <br /> Does existing septic system comply with Ord . #549 : fe6 a_ <br /> Unknown If <br /> no, explain: <br /> Deecribp peptic installation to be installed: <br /> Z . 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 /> No__.�� Sample of well water taken: Yes No__4 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: <br /> 4 . ELI. MOSQUITO OR V Z^. ZCiT ENTIAL <br /> State possible vector potential R.c necessary control: p� <br /> 5 . TOTT,ET/BATH FACILITES . <br /> No . & location existig: Additi nal <br /> facilities needed <br /> 6 . PREVTOQ2 OPERATION HISTORY <br /> �,�,t/c�r�,C•�;t c�` -- -,,�`',�,��,�v.�/' �'rp orf ' <br /> 7 . QE.NERAL SANTT6TION <br /> State any problems not previously noted: <br /> 8 . F- O l , ION DEL�JSITY <br /> Appx. No . People per 6q. mi. �,��e'�vr:` 'ems ��✓' . i ''' <br />