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1 . LZl:Li7.AGE <br /> Distance to Public Sewers dzM"�s Connection necessary: Yes Noz <br /> Does exist septic system comply with Ord . #549 : Yes No_ <br /> Unknown ✓ If/ no, explain: <br /> Ay <br /> Orrtn <br /> Describe septic installation to be installed: <br /> / ;7 1.aP ��! �!'r'A•-GC C/� �t7J � /ll.0 rn��.2r � �✓D�1Yn C <br /> 2 . WATER SUPPLY <br /> Is wa r supplied by private well: Yes `­�No Is well proper: <br /> Yes No State deficiency - — <br /> Doe"xisting or porposed use make this well p�lic water: Yes <br /> No Sample of well water taken: i'es NG Date taken <br /> Results Additional information or comments <br /> A).e c J .,e 11 -,,s4 4-e 4,- (&.d <br /> 3 . GARBAGE & REFUSE <br /> . Licensed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . EL S O Q I YECTOR POT .MIA , <br /> State ssible vector potential & necessary control : <br /> 5 . t , <br /> No. & location exist - g: Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HISTQRY <br /> 7 . GENERAL SANITA`1'ION <br /> State any problem riot previously noted <br /> 8 . POPUL TTt DFN=j <br /> Appx. People per sq. mi . _ <br />