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/16 06 67' <br /> 1 . SEWAGF <br /> Distance to Public Sewers N A Connection necessary: Yes No_ <br /> Does existing septic system comply with Ord . #549 : Yeg�,.. No <br /> Unknown If no, explain: <br /> Describe septic installation to be installed: <br /> lvekl W/ sus s•ti f%l/Z. �1ew/JM e <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes NoX— Is well proper: <br /> Yes No State deficiency:Does existing or porposed use make- this well public water: Yes <br /> No Sample of well water tarsen: 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 me hod: <br /> Potential problerr,: <br /> 4. ELY MOSQUITO QR VQT(') zCi'rX TIAL <br /> State possible vector potential & necessary control : <br /> v y <br /> 5 . TOTLET/BATH FACTU TES <br /> No . & location existing : ✓UI Additional <br /> facilities needed <br /> 6 . PREVTOfTra OPERATIOtd HITORY <br /> 7 . QENER L 261IIT6TION <br /> State any problems not previously noted- <br /> 8 . <br /> oted:s . POPULATIO14 DENSITX <br /> ADDx . No . People Der ca . mi . <br />