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RRWAGHYes _ <br /> Distance to Public Sewers � D ConnectionOnecessary, Yeses No— <br /> Does existing septic system comply <br /> Unknown.,. If no, explain: <br /> cel"w q4p Li -s <br /> Amo of . `7`G.� e a,e ecf (each -0G -/a,te. <br /> S �'F�e jaV ,v,cse..� <br /> Describe septic installation 'be stalled: Q <br /> 2, WATER ,5(]PPL'L <br /> Is wat�.r supplied- by private well: Yes 'f No is well proper: <br /> Yes ✓ No State def4. <br /> iciency: <br /> e,11 <br /> cc�f Co <br /> Does existing or porposed use make this well public Water: fes <br /> No Sample of well water taken: Yes No ✓ Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & RSFUSP <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal. method: <br /> Potential pro em: <br /> 4. EMOR POTENTIAL <br /> State possible v for potential & n cessary control: <br /> 5 . nILET/BATH EAGIT, TES <br /> No. & location existing Additional <br /> d <br /> facilities needed <br /> ZS- <br /> 6.. Or] r, n n <br /> 7. <br /> State any prob me not Previously noted: <br /> 8 . O 1 Sj v <br /> Appx. No. People per sq. mi. <br />