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e1O � P d066rOr- s1{�- 3)(J / / 4e <br /> f/ cGa r- Nd <br /> r Za:7 <br /> ar(* . mer on �vrr as npf iry Y y. <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 /> _5d 410 z4ar5Yz1, hose o3 k.05Mwc /" !o/ 9/o r ter^ dray �o fr er�t°. <br /> Describq septic emstalation tp 'be installed: <br /> w se� s <br /> —tys—,_y <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : YesesNo Is well proper: <br /> Yes, No State deficiency: Abd /lt�®�/r 4 res¢ ex"'h , <br /> o See Si 1,1�f� <br /> v aq ��S atm rapPr�. <br /> Does existindor porposed use make this well public water: Yes <br /> Nom_ 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 . =,.- MOSQUITO Oh V ZQ_T Z2r2N1IAJ.L <br /> State- possible vector potentiftl Pz necessary control : <br /> r� <br /> 5 . TOT_LET/$ATH FACILITES <br /> No . & location existing : ��! Additional <br /> facilities needed _ <br /> 6 . PREyVTOPE OPERATION HISTORY <br /> adA, ,o� r r►to (,y� UCAS l <br /> 7 . GENERAL SAtlI'?' '1. O <br /> State any problems not previously noted : <br /> 3 . 'O P ILATION D i STIY <br /> Appx . No . People per rq . mi . <br />