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J <br /> 1 . SEWAGE <br /> Distance to Public Sewers Connection necessary : Yes No_ <br /> Does existing septic system comply with Ord . #549 : Yes No_ <br /> Unknown If no, explain: <br /> Describe septic installation to be installed: <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes No Is well proper: <br /> Yes- " No st9 F rtr Fi � ,E3t <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 Addi-tional information or comments .( P e , <br /> L S ta, IE IQj00. <br /> 3 . GARBAGE & REFUSE Joh- �a-- V <br /> Licensed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: - <br /> 4 . FLY. MQSQUITO OR YL:,--,' t ' tTENTI L <br /> State possible vector potential & necessary control : <br /> 5 . T LI ET/BATH FACILI7TS <br /> No. & location existing: __.. Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION H=O ,r- <br /> 7 . GENERAL SANITATION <br /> State any problems not previously noted : .— <br /> 8 . POPULATIO) DEi�SIT1 <br /> Appx . No . People per sq. mi ._— <br /> rd <br /> - �,� � �3 � � ��• �/ � tom" G'�s <br />