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SKWAGFL <br /> Distance to Public Sewers "M'�`SConnection necessary: Yes ,4 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 /> ti� • <br /> 2. WATER SUPPLY <br /> Is water suppliedby private well : Yes v'I' coo Is well proper: <br /> Yes No State deficiency: <br /> Does existing c make this well public water: Yes <br /> No Sample of well Water taken: Yes No �� Date taken <br /> Results Additieon �al_ information or comments <br /> 7('q3- vv.¢- Gavrsa.fiw, w Ur'5 ..ion 06_9 s�zc4ea <br /> ka,e 4�TJ,-h,C2.S nu d Lze a ✓ztrSr_en t <br /> 8 . ARBAGE & RRFUSR �'� <br /> L censed scavenger pick-up: Yes No Service Area 'e• <br /> Ot r proposed disposal method: <br /> Pot e tial problem: <br /> 4. F UT3:Q QR I1QT_0R E!0'rCNTT_AL / <br /> State pos ible vector potentiftl & necessary ontrol: <br /> i <br /> 5. Tn_TLET/BATH FACII ' <br /> No. & location exis ng: Additional <br /> facilities needed <br /> 6. pggyTona opgRATToN HT S n <br /> ?. GENERAL SANTTATT <br /> State any prob me not previously noted: <br /> S . I ST v <br /> Appx. o. People per eq. mi. <br /> 7� <br />