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SRWAGEL- <br /> Distance to Public Sewers Connection necessary: Yes No_ <br /> Does existing septic system comply with Ord. #548 : Yes No— <br /> Unknown— <br /> o—Unknown - If no, explain: <br /> . r <br /> Describe septic installation to 'be installed.-. �- - �- - - <br /> 4 <br /> 2. WATER 1 <br /> Is wat r supplied. by private well : Yes No is well proper: <br /> Yes--Vo— State deficiency: <br /> A/ 1` P. 7 7- <br /> Does existing or o e this well pc water: Yes <br /> No�I.c--'Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments- - n <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem:., - - <br /> 4. ACTOR F' <br /> State possible vector potential & nece rY control: <br /> 5. TQTTjFT/BATH EACIT,TTFS <br /> No. & location existing: Additional <br /> facilities needed <br /> x", <br /> 7. QENERAL SAtTTTATI NSAtTTTATTONN <br /> State any problems not previously noted: <br /> 3 . POEULATIQU 12EUITY <br /> Appx. No. People per .sq. mi. <br /> r'-p -%-T 0-A-010 0- <br /> q 4�� <br />