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1 • S EWA G'R <br /> Distance to Public Sewers 44 Connection necessary: Yes Nd-- <br /> Does <br /> amDoes existing septic system comply with Yes_ No_ <br /> Unknown If no, explain: V-1/e cJ <br /> Describe septic installation to -be instal epi: <br /> �;, SPC ',• .�c� � �°s.... 76✓ .�o/ i" Y' ,-ri 9c.e N , <br /> /, _ P ", w :(-- <br /> 2. {CATER SUPPLY <br /> Is water supplied by private well : Yes sG No Is well proper: <br /> Yes—Z No State deficiency: <br /> U <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 dispos met od: M_ <br /> Potential problem: jlf * .2 - - <br /> 4 . FLY . MOSQUITO OR VECTOR PO'fENTTA <br /> State possible vector potentiftl 8A necessary control: <br /> 5 . Tnrl,ET/BATH FACILITES <br /> No. & location existing: Additional <br /> facilities needed <br /> 6. PREVTOUS OPERATION HISTORY <br /> 7 . GENERAL SANIIATION <br /> State any problems not previously noted: <br /> fzzi= <br /> 3 . BOPULATTON DENSTT" <br /> Appx. No . People per eq. mi. <br />