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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: Nor <br /> Unknown If no, explain: / <br /> o`o���' Ty.e F ci//1✓ ��/.girl//odf S d 9/O.t%,,'�9�0� �%y�Oc� mei T ��� l�iP��i9,P� <br /> ./,G/�.�„Q�.�%6 4/9✓�F'-.tori�.!`f c�/J 9/1 D A�fa//Ydli✓��'%�,/' 1�i7'�'Op'� ,p� �r't'",f.,' <br /> �a..U� i✓ �� .Q%F /yF f��e yD ci.�� 4./�,l�i X46 ydo g �'�� -c'�.�4_ �,Off'�Q 6�1�� �,/- a.r <br /> I�F <br /> scrllbe septic installation to be installed:.4_/ �� <br /> 17 <br /> 2 . WATER SUPPLY <br /> Is water supplied b , private well : , Yes NoIX I 41kroper: <br /> Yes No State deficiency : <br /> �✓ �.c'o�Ef,�?',./'�,9�, �cli�k/E,l,/,�l/-���'.!�c�j di,�lil�c i� ��%�i9,Pe%�/�,1�� <br /> Does existing or purposed use make this well public water: Yes- <br /> No <br /> es <br /> Nom�__ Sample of well water taken : Yes No->< Date taken <br /> Res"uYts 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 . =, MQ,5QUTTQ OR y ;;;m PC)LEV.jA.L <br /> State possible vector potentift.l necessary control : ��� F <br /> 5 . T_()JLET/BATH FACIII-l'F,a <br /> No . & location exi ot'Lng : Additional <br /> facilities needed _ <br /> 6 . PREVIOUS OPERATION H_13_Tf21 <br /> 7 . GENERAL SANITA'1'CM <br /> State any problems not previouL,ly note'l.. � <br /> 8 . POPULATIQN DENSIT � w <br /> Appx . No . People per Fq . m:i . . ����/�® � !�c�✓�1c� .� <br />