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1 . SRWAGR <br /> Distance to Public SewersConnection necessary: Yes✓ Nc <br /> Does existing septic syst comply with Ord . 0549 : Yes_ No_ <br /> Unknown If no , explain : Qp / <br /> Describe septic installation to be installed: <br /> h <br /> t4A UP <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes ✓ No_ Is well proper: <br /> Yes_ No_ State deficiency: <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 /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes `�No_ Service Area No . <br /> Other proposed disposal method: rl&yu <br /> Potential problem: /10 <br /> 4 . ELY . MOSQUITO OR VROTOR PQ'r2,NTTAL <br /> State possible vector potential & necessary control : IZ&k4 <br /> 5 . TOILET/BATH FACILITES <br /> No . & location existing: Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HISTORY <br /> i �41e^�, (Aad 4dtjA*- (eb <br /> 7 . GENERAL SANTIA ETON <br /> State any problems not previously noted: 4404 <br /> 9 . PO 1 ,AT ON DFN.STTY <br /> Appx. No . People per sq. mi . <br />