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s � <br /> 1 . SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes 902L <br /> Does existing septic system comply with Ord. #549 : Yes= o_, <br /> Unknown,►/ If no, explain: <br /> �' 7�--G,�j! , 7(--703 <br /> mal — <br /> Describe septic installation to be installed: <br /> e - <br /> 2 . WATER SUPPLY <br /> Is wz,-/Vier supplied by private well : Yes No Is well proper: <br /> Yeses,, No State deficiency : <br /> I <br /> Doe xisting or porposed use make this well public water: Yes <br /> No Sample of well water taken: Yes No Date taken— <br /> Re s <br /> akenRes lis Additional information or comments <br /> 3 . GARBAGE t' REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method: <br /> Potential pr6blerr,: <br /> 4 . FLY M SGS ITQ QR, VE,^.TO PS)'f ,,T <br /> State possible vector potennecessary control : <br /> 5 . TOTLETiBATH FACILITES X <br /> No . & location, existing-_\_s' Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HISTORY, <br /> 7 . GENERAL SAiIT'r.1, TION <br /> State any problems not previously noted.,-- <br /> 8 . <br /> oted:_S . RopULATTON DE `'T v <br /> Appx. No . People per rq . mi . <br />