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1 . SSW ASF, <br /> Distance to Public Sewers Connection necessary : Yes_ No_ <br /> Does existing septic system comply with Ord , 4549 : Yes— No_ <br /> Unknown jf no, explain - <br /> De <br /> xplain: <br /> De/g[cribs sqp is ingtal�latipn to�/'be installed: <br /> _ ��POi'L'�'lJy/II�CG 9 "Oir��-1 <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes No_ Is well proper: <br /> Yes_ No_ State deficiency :— <br /> Does <br /> eficiency :_Does existing or �orposed use make this well public water: Yes <br /> No Sample of well water taken: Yes_ No_ Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & RFFUSF. <br /> Licensed scavenger pick-up: Yes— No_ Service Area No . <br /> Other proposed disposal method: <br /> Potential Problem: <br /> 4 . =i MOSc7UITO OR V E^'I'O EC'P=A:4 <br /> State possible vector potentiFtl & n --essary control : <br /> 'v . TOTLET/BATH FACILITES <br /> No . & location existing : Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HISTORY <br /> 7 . r�PTiIN <br /> State any problem not previously noted: — <br /> S . <br /> oted: _S . POPULATI N AFiiSTTY <br /> Appx. No. People per sq . mi . <br />