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1. SEWAGR <br /> Distance to Public Sewers Connection necessary: Yes N04 <br /> Does existing septic system comply with Ord. 11549 : Yeses. No— <br /> Unknown If no, explain: <br /> Descri e s ptic installation to 'be installed: �'e?e <br /> 2. WATER SUPPLY <br /> Is water supplied by private well : Yes No FIs well propgr: <br /> Yes No State deficiency: �zf! '•� �✓�� '"�•��/'•� ' ✓-+��.c'1. ..�>�.� � : <br /> Does existing or porposed use make this well public water: Ye6s <br /> No Sample of well water taken: Yes NoDate taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & R .F TS . <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . Ell, MOSQUITO nR <br /> State possible vector potentiztl 8,c necessary control: .�''c� <br /> 5 . TQILET/BATH FACILITES <br /> No. & location existing: 4�� Additional <br /> facilities needed _ <br /> 6 . PREVIO"5 OPERATION HISTORY <br /> 7 . QENERA . SANITATION <br /> State any problems not previously noted: <br /> 1 <br /> 8 . BOPULATION DENISIIX <br /> Appx. No . People per eq. mi gkn �,f' .! —.�r� ✓�� �, ' <br /> 7 <br />