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s <br /> 1. 9EkIAGH <br /> Distance to Public Sewers Connection necessary: Yes No— <br /> Does existing septic system comply with Ord, #549 : Yes Nom <br /> Unknown If no, explain: <br /> r <br /> c�` +�►w of �rrcfi�., <br /> Describe septic installation to 'be installed: <br /> 37 Cy'e a <br /> J <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well: Yes Nom Is well proper: <br /> Yes No State deficiency: <br /> a 4Mw t df <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 coLmm/e✓nts / <br /> p 3 7y <br /> C'V V y-rtVV llG r vl e a!- ''Cc o l 4e le Ae! <br /> s . rAEBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed dispa al method: <br /> Potential problem• rva y /42SG(1a , <br /> 4. EIS, Mo d�U.l m- 012-y 'Q' Pol NTIAL <br /> State possible vector potentitsl necessary control : <br /> 5. MILET/BATH EAt"IL TES <br /> No. €c location existing: Additional <br /> facilities needed _ <br /> 6 . PRF,YJQT15 OPERATION HT31QR <br /> ,v+rror-� a3t <br /> JA) I lk 0 eVA#4a5 59M_ a /a't 15 VO- Salk, <br /> 7 . UNERAL SAJITAT,T_QN <br /> State any problem: not previously noted: r wt4r At o'� <br /> 3 . - Pc)PULATT0j; DENSTTY <br /> Appx, No. People per sq. mi. <br />