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1 . SAGE <br /> Distance to Public Sewers _ Connection necessary: Yes No, <br /> Does existing septic system comply Vth Ord . #549 : Yes No_ <br /> Unknown If no, explain: --7% ter <br /> Describe septic inste1lation to 'be installed: <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes No Is well proper: <br /> Yes No State deficiency: z2fze =� .•��//�`.G.G <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 /> 3 . GARBAGE & REFUSE <br /> Licensed scavenaer pick-up: Yes No .X' Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. FLY, MOSQUITO OR Vr,: TQQR PQ'[2,N TA . <br /> State possible vector potential & necessary control: <br /> 5 . TOTLET/BATH FACILITES <br /> No. & location exieting: // Additional <br /> facilities needed <br /> 6 . PRRVIO05 OPERATION HISTORY <br /> 7 . GENERAL SANTIATTON <br /> State any problems not previously noted : lz:�� <br /> 8 . POPULAITON D ,YSTTY <br /> Appx. No. People per eq. mi. �/�'�-C�-�E �a,�-,•r.E,rc�r�.G <br />