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4 <br />5 <br />1.9 <br />7 <br />3 <br />SKWAGE <br />Distance to Public Sewers Connection necessary: Yes_ No_ <br />Does existing septic system comply with Ord. 11549: Yes_ No_ <br />Unknown IE no, explain: <br />Describe septic installation to be installed: <br />WATFR 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 />GARBAGE & REFUSE <br />Licensed scavenger pick <br />Other proposed disposal <br />Potential problem: <br />Yes _ No_ Service Area No. <br />State possible vector potential & necessary control- <br />TQTrjFT/13AT9 FACTTJ / <br />No. ec location existing: Additional <br />facilities needed _. <br />GENERAL SANITATION <br />State any proi)lems not previously noted: <br />POP 1 .AT f1N )E td <br />Apnx. No. People per sq. mi. <br />— <br />d do'7 7 - <br />1-v-` t 10� i P4 h A .•-p <br />�v ire ..e.� � -P�+� �,` f�jr ��(iL�, _�� �•o ✓� <br />