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I. SEWAGE (2) <br /> Distance to Public Sewers Connection necessary: Yes No <br /> Does existing septic system comply with Ord. 0549: Yes No ` Unknown <br /> If no, explain: �J <br /> _.e7 � <br /> Describe septic installation to be install p p ",gt�=lis e =, <br /> /Ga. d <br /> Additi nal information or comments: <br /> 2. WATER SUPPLY 7T' <br /> Is water supplied by private well: Yes _ No _ Is well proper: Yes _ No _ <br /> State deficiency: �/Jj /� pp <br /> Doe or proposed use make this well public water: Yes _ No <br /> Sample of well water taken: Yes No v Date Taken Results <br /> Additional informationorcomment's: <br /> 3. GARBAGE &,REFUSE <br /> Licensed scavenger pick-up: Yes _ No _ Service Area No. <br /> Other proposed disposal method: ��'� �Q� IL_�4�� <br /> Potential problem: �� e <br /> 4. FLY, WSQUITO OR VECTOR POTENTIAL <br /> State possible vector potential & necessary control: 4 ) <br /> 5. & POLLUTI iJ POTENTIAL <br /> State possible burning or processing pollutants & necessary control: <br /> i <br /> 6. TOILET/BATH FACILITIES <br /> No. & location existing: Additional facilities needed <br /> 7. PREVIOUS OPERATION HISTORY <br /> 8. GENERA SANITATION <br /> State any problems not previously noted: <br /> 9. POPULATION DENSITY <br /> Appx. No. People per sq, mi. <br /> EH 06 06 3/71 <br /> eu� �, <br />