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NoSEWAGE <br /> 1 <br /> Distance to Public Sewers IVo7kA,'�a Connection necessary: Yes Nom <br /> Does existing septic system comply with Ord . #549 : Yes No_ <br /> Unknown If no, explain: <br /> Desribe septic installs ion to be installed: <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes No Is well proper: <br /> Yes ✓ No State deficiency : <br /> div uve( o e- . <br /> �u�i� �r� kZ-G� � �.�2,t�j-) .l!� /,l!/,C�� lea f �j0/�j- _�7 Gd•� � (,� ?�-, G!/�P �rA 4Q/ �.1/h't..-"'�, <br /> Does existing or porposed use make this well public✓ water: Yes <br /> No Sample of well water tarsen: Yes No Date taken <br /> Results Additional information or comments <br /> M H '7� <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem:_ 6 G� �iOQi` <br /> 4 . E.LYL MOSQUIT0 OR VZ^T=) ES)Tr MAILL <br /> State possible vector potentiftl & necessary control: <br /> �C <br /> 5 . TO ET/BATH FACILITES <br /> No . & location existing. 3 �� 7 t py� ret" lri` dditional <br /> facilities needed <br /> 6 . PRF,yIot72 c;p ,RATION HISTO r <br /> 7 . GENERAL SAILUATION <br /> State any problems not previously noted:_ <br /> 3 . PL > 1 ATION DE t4S?j <br /> Appx . No . People per sq . rr,i . <br />