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/� 1 vpr,s� <br /> N6 Iqr/"//a 0^- 1 U . <br /> 1. SEWAGF� <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 /> ScI ,�r-- <br /> Descr be peptic installation to 'be installed, <br /> � �� C, ✓ OS C. D� Gam- e <br /> �- <br /> 2. WATER SUPPLY <br /> Is water supplied by private well : Yes No Is well proper: <br /> Yes No.,'--- State deficiency: . vp�( ►aea{S � �e aQp�/„�(s ! ��,, <br /> c S Com co ad�. � <br /> 00/ u-s?�/ �1Px� GfiAy �b�if� `t��asQS <br /> �d �D �rS�Youf NAS Gbodf a 3/ C!!5/^� <br /> Does existing or porposed use melte tlis 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 disporial method: <br /> Potential problem: vu/d ,dao iz o ec; /�l giSe <br /> 4. MOSQUITO OR V ^.T ) EUXISTTAL <br /> State jossible vecto potentiftl & necessa y control: s _ <br /> - ��— �U�-f'�- r�a�, or✓Qn��< 5w�,ti� ('� �e' `ff�o,,� <br /> 5 . TOILET/BATH FACILITES <br /> No. ec location existing: AIA Additional <br /> facilities needed <br /> 6. PREVTOna OPERATION HISTORY <br /> ��l� 2�l� /ON►� w ni i,rS �yR/l i Pim.. �0 <br /> 7 . GENERAL SANITATION <br /> State any problems not previously noted: <br /> 3 . EOPULATIO14 DEHIpTT`= <br /> Appx. No . People per sq. mi . <br />