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l Distance to Public Sewers I ,,, tt Connection necessary: Yes_ No� <br /> Distance <br /> Does exist�ri9 septic system comply with Ord . 16549 : Yes_ No_ <br /> Unknown ✓✓ If no, explain : 7 <br /> Describe eec installataion Q oo be installed: <br /> o 6e- s <br /> Z . WATER SUPPL'I ✓ Is well proper: <br /> Is watgr supplied b: private well : Yes No_ <br /> Yes�C No_ State deficiency : <br /> At <br /> ropo:ur <br /> Does existinj or use make this Weil public water: les <br /> No_ Sample of well water taken: Yes_ N0_ Date taken <br /> Results Additional information or comments <br /> /V&�) ut I.,e c,,,s <br /> g , Q A R R A G RBFUSs No_ Service Area No . <br /> Licensed scavenger <br /> pick-up : Yes_ <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 , FLY MOSQUITO OR yTCTOR POTCNTI t,�� necessary control: <br /> State possible vector potential <br /> 5 . TOILET/BATHEArT•_ Ir TF.; Additional <br /> No . & location existing : <br /> facilities needed <br /> 6 . PRFVIOfi_3nPERATTO HISTORY <br /> �rci(U. idS <br /> 7 . GRNFRAT, SA27 TATTOR <br /> State any problems not prevlou--ly noted: <br /> 8 . POPnr ATTOta 2F' ^T V <br /> Appx . No . People Per aq . m�- <br />