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' f <br /> 1 . 5EWAGE S"o t <br /> Distance to Public Sewers �� TConnection necessary: Yes No <br /> Does existing septic system comply with Ord . #549 : Yes No7`� <br /> Unknown If no, explain: <br /> Al )a Cisrs717� <br /> Describe septic installation to be installed: <br /> A 26,ml <br /> 2 . MATER SUPPLY <br /> Is water supplied by private well : Yes No FIs well proper: <br /> Yes No ./ State deficiency : <br /> Does�xisting or porposed use make this well pub is water: Yes <br /> No _ Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> Licensedcavenger pick-up: Yes No Service Area No . <br /> Other prop ed disposal method: <br /> Potential problern: ' <br /> 4 . ELY-'- sc 0 ' yZ^.TO Psf ENIJAL <br /> State possible �ctor potentiitl & necessary control: <br /> 5 . TOILET/BATH FACILITES <br /> No . & location existing: Additional <br /> facilities needed _ <br /> 6 . PREVIOCTS OPERATION HISTORY- <br /> 7 . <br /> ISTO) r7 . GENERAL SAIU A` LQ1 <br /> State any pro'blems not previously noted:— <br /> 3 . pnpuL ATT014 r)rENSTTY <br /> Appx. 'No . People per rq . rn i . <br />