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# of rIS ti„k r 1 <br /> Distance to Public Sewers, Connection necessary: Yes No._., <br /> Does existing -septi stem comply with Ord. #549 : Yee No._,_ <br /> Unknown_' If no explain: <br /> Describe septic installation to 'be installed: <br /> 3 <br /> i <br /> 2. MATER SUPPLY <br /> Is water supplied. by Vete well : Yes Na Is well proper: <br /> Yes iso State fici_ncy. <br /> ,a <br /> Does existing or porposed use make this well public Water: Yes <br /> No— Sample of well water taken: Yes No � Date taken <br /> Results Additional information or comments <br /> 2L J_ &22 4:sr2e,,.& <br /> :� <br /> S . GARBAGE & REFUSE <br /> Licenced scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: 'a <br /> Potential problem: <br /> 4. ELY, MQ30IM QR ECTOR POTENTIAL <br /> State possible vector potential & nec '—dontrol: <br /> r, <br /> S. TDITIET/BATH FAQILI <br /> No. & location existing: Additional <br /> facilities needed <br /> 6. Baxyjoasr, gRATTQN HISIngy <br /> 7. GENERAL.. 58HI ' IOPS <br /> State any problems not previously noted: <br /> i <br /> ,a <br /> $ . E0PULATj0M DENSTTY <br /> APpx. No. People per .aq. mi. <br /> 'i <br /> 1 <br /> e <br />