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1 . SEWAGE <br /> Distance to Public Sewers i- -4 Connection necessary: Yes— No <br /> Does existing septic system comply with Ord . 11549 : Yes_ No <br /> Unknown If no, explain : <br /> /Vd .or69:'A .ti �C �EJS4cr <br /> Describe septic ins llatio t 'be installed: <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes _ No�_ Is well proper: <br /> Yee_ No_ State deficiency : <br /> Does existing or porposed use make this well public water: Yee px !'/' � <br /> No Sample of well water taken: Yes_ Nom Date taken <br /> Results Additional information or comments <br /> (,ued 4� he c.e-,.rY-ncc4ed <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes_ No_ Service Area No . <br /> Other proposed disposal method: <br /> Potential problem : <br /> 4. FLY, MOSQUITO RV �^.TO 'fj TAL <br /> State possible vector potential A necessary con ol : <br /> k, ik_c //7���Crct, 7`t Z, FP - /.es <br /> 5 . JOTLF.T/BATH FACTLITES <br /> No . & location existing : _ Additional <br /> facilities needed <br /> 6 . PREVIOUS OPER ATT�ISTnRY <br /> a rwf - a0✓oX tzc"S <br /> 7 . GENERAL SAJITATION <br /> State any problems not previously noted : <br /> 3 . hQE11LATION DENSITY , _D n�� ��� <br /> Appx . No . People per sq. mi . /� GCS <br />