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�• SKWAQE <br /> Distance to Public Sewers Connection necessary: Yes NoZ <br /> Does existing septic system comply with Ord, #545 : Yes No— <br /> Unknown If no, explain: <br /> Describe //sept# installation to 'be installed: ff /✓�� ,, � <br /> O Cr !moo p//l 'l/-• /�✓ � I. / <br /> 2. tP <br /> �TRR SUPPLY <br /> PL I . <br /> Is Water supplied. by private well : Yes No IE well proper: <br /> Yes No State deficiency _ , <br /> r <br /> _ r'�/,�'.� �.a�� �aZ o �o�/�d .�"!�"E� 'c � .A . r�•,► its <br /> �.C�f t�Pd�F -��t�.r�a✓ �194f 9 c'Ce�.l��qJ �d •�lddd�:' .�.�.��GP- �.���.r��r�//f/� <br /> Does existing or porposed use make this well public Water: Yes <br /> NoLY::� Sample of well water taken: Yes Nom Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> Lice.naed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. ELT, MOSQUITO OR VECTOR FuEENTIAL <br /> State possible vector potential & necessary control: <br /> 5 . TQILET/BATH FACILITES <br /> No. & location existing: - _. Additional <br /> facilities needed <br /> S. ERM_YIOUS OPERATION HISTORY <br /> 7 . 05ENERAL SANITATION <br /> State any problems not previously noted: + <br /> S . POPULATTON DRHSTTX <br /> Appx. No. People per .sq. mi <br />