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Distance to Public Severs -,ze— connection necessary: Yes No� <br /> Does existing septic system comply with Or . #W Yes No� <br /> Unknown If no, explain: ' F y �i � D,. <br /> Descri a septic installation to 'be int led: <br /> E <br /> 2. WATER SUVELY <br /> Is water supplied. by private we 1: 'Yes . Lio I0 we,11 pro. <br /> Yeses No State de) c hncy: '�� �• <br /> Does existing or porposed use make this we'll public water: Yes <br /> No_a Sample of well water taken: Yes Nom Date taken <br /> Results Additional information or comments <br /> i <br /> 3 , gaRBAGE & REFOSF, <br /> Licensed scavenger pick-up: Yes No Service Area No.� <br /> Other proposed dispopal method: <br /> Potential problem: /ate° I <br /> E <br /> 4. FLY, OR VECTO-2 )- E <br /> State possible vector potential necessary control:.��� <br /> 5. TO__ILET/BATH FArI111TE3 <br /> No. & location existing: Additional <br /> facilities needed <br /> 6. BREXIOnS OPERATIQUO <br /> /Wf_ .`-• ,�� 0 o .D / mfr <br /> 7. GENERAL SAILITATION <br /> State any problems not previously noted: <br /> a . PQEjJT.ATTQj4 nEHaTTV 01 <br /> Appx. No. People per eq. mi. ' •�� d�d c�✓�.d / _.�..— <br /> i <br />