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1 . gRWA E <br /> Distance to Public Sewers Connection necessary : Yes_ No 2L <br /> Does exi11irg septic system comply with Ord . #549 : Yes_ No— <br /> Unknown— <br /> o_Unknown ✓ If no, explain: <br /> /1�0 .S.�pfz a yQt..�.�.-✓f-s a��i �t <br /> Describe sec installation to be installed: <br /> v b ,sk-.- d a 4e . <br /> 2 . WATER SUPPLY <br /> Iswatgr supplied by private well : Yes No_ Is well proper: <br /> Yeses[ No_ State deficiency : <br /> At r�,tll <br /> ''°P°usl <br /> Does existing or use make thia well public water: Yes� '� <br /> No—, Sample of well water taken: Yes_ No Date taken - <br /> Results Additional information or comments <br /> /U ua �al 4-o 're c w&s+nLerkd w;t l 6c <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 OE VECTORPOTENTIAL <br /> State possible vector potential & necessary control : <br /> 5 . TOTLFT/BATH FACILITES <br /> No . ek location existing : Additional <br /> facilities needed <br /> 6. PREVIOUS QE!FRA3!I Ott HISTORY <br /> 7 . GENERAL SAN TATTON <br /> State any problems not prevlouely noted : <br /> A)Uh,¢„ <br /> a . P T ,AT ON )ENS <br /> Appx, No . People per sq . mi. <br />