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1 . SEWAQE /� cll'._n <br /> Distance to Public Sewer Connection necessary : Yes No_ <br /> Does existing septic system comply with Ord . #549 : Yes No_ <br /> Unknown If no, explain: <br /> Describe septic installation to be installed : <br /> 2 . WATER SUPPa a <br /> Is water supplied b1.7 private well : Yeses do Is well proper: <br /> Yes_, No State def 4 ciency : <br /> Does existing or porposed use make this well public water : Yes <br /> No Sample of well water taken : Yes No Date2=kenResults Additional information or comments �� <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . ELI,,- MOSQUITO ORVEs TL?E__L'S�'I'3.NTIAL <br /> State possible vector potential & necessary control : <br /> 5 . T ILET/BATH FACILIT- La- <br /> No. & location existi;ig : �._- Additional <br /> facilities needed------ <br /> 6 . <br /> eeded __—_6 . PREVTOUS OPERATION Hl;iTORY <br /> 01 <br /> 7 . ENI+.RAL SANITAIJS1 <br /> Sta.te any problems not previously noted : <br /> 8 . POPUL 97 Q.. DENSITY <br /> Appx . No . People per Bq. mi <br /> LX <br /> �a <br /> � - � ,- n� � V ,�8 6 a ✓ C�i-•�--,/4 ion`' Y!� <br /> e x �c _ 4.--; <br /> w , l/ & y <br />