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11V0 UG 5%s <br /> 1 . SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes Nod/ <br /> Does existing septic system comply with Ord . 0549 : Yes No <br /> Unknown If no, explain: <br /> Descr be septic instal�ati n to 'be installed: <br /> 2 . WATER SUPPLY <br /> Is water supplied by privatera�1�1 : Yes � No Is well proper: <br /> Yes. No State deficiency : e577c Ue& 51�77� <br /> ^ S�/ca!, cam • <br /> U 4V k'-djQ,-t Aee ,.S - �'�aSS 60^41,^4401 7� S4141,0 04 <br /> Does existing or porposed use make this wEll public water: Yes <br /> No Sample of well water taken: Yes No 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 . ZLY,_1mCSoU_LTQ oRy -^TOS PL)fTNT_JAL <br /> State possible vector potentiftl 8z necessary control : <br /> 5 . TOTLET/BATH FACILITES <br /> No . & location existing . Additional <br /> facilities needed _ <br /> 6 . PREV_TOUS OPERATION HISTORY- <br /> 7 . <br /> ISTORY7 . GENERAL SA1UjA=Q <br /> State any problem~ not previously noted : <br /> 8 . pnpULATION DE CSITY <br /> Appx. No . People per rq . rr,i . <br />