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1 SEWAGE shire <br /> Distance to Public Sewers '%L 'Connection necessary: Yes No <br /> Does exirt,-ing septic system comply with Ord. 41549 : Yes No_. <br /> Unknown_ If not, explain: <br /> G.rC-e. <br /> Describe septic instal ation to be installed: <br /> 2 . SEATER SUPPLY <br /> Is w€t�er supplied by private well : Yes .,� No Is well proper: <br /> Yes No State deficiency: <br /> Does '�existing or porposed use make this wellptb is water: Yes <br /> No A' Sample of well water taken: Yes No!fDate taken <br /> Results Additional information or comments <br /> 3 . FUSE <br /> License cavenger pick-up: Yes No Servie /Area. No . <br /> Other proposed disposal method: <br /> Potential probler,,: <br /> 4 . FAL MOSQUITQ QR V z^T0 E2MB1jAL <br /> State possible vector potentiftl & nec sary control : <br /> 5 . TOTLET/BATH FACILITE73 <br /> No . & location existing: X Additional <br /> facilities needed <br /> 6 . PRF,yIOna npEgAT ToN HISTORY <br /> 7 . GENERAL SANIT,AT _N <br /> State any problem: not previous].y noted- <br /> 8 . <br /> oted:8 . EnpULATI014 DFijSTly <br /> Appx. No . People per sq. mi . <br />