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1 . SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes No_ <br /> Does existing septic system comply with Ord . #549 : Yes No— <br /> Unknown et< <br /> o_Unknowns If no, explain: <br /> *I cc .�t <br /> Describe' sep-tic i/n'st l lation <br /> �/'D r ?C,., <br /> i S red r-t � '` �-rc ' S '� �4 I�-•.S � •olo., q•,. <br /> a 50 e s rco Z 4 �l1• <br /> 2 . WATER SUPPLY 1 <br /> Is water supplied by private well : Yes ko No Is well raq�per: <br /> Y�',- No k _ State deficiency: ���� hc,C� 1�.� ,, o�c)�rrc) ��+ <br /> ToI 'oaf . . <br /> C. dr Ltur'�- 4J 2 co 6-'. .0c, -4t'.1?0CIf <br /> Does existing or porposed use make this well public water: Yes <br /> NoK Sample of well water taken: Yeh No—_ Date taken <br /> Results Additional information or comments <br /> GC Le(-'I o G't i r ` `2 I V ^'!"r . 1 I I 1 - �,G...0 'F :A`I!`;,1� l r• �'- F t <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, MQSOUITO OE y C F-C)UNTIAL <br /> State possible vector potential necessary control ! <br /> 5 . TQILET/BATH FACILITS <br /> No. & location existing: Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HISTORY <br /> 7 . GENERAL SANI'T.A= <br /> State any problems not previously noted : - <br /> 8 . <br /> oted : —S . F.QLL`()�_T)Fx ;3ITY <br /> Apex. No. People per sq . m i_ .-_ <br /> Lfm <br /> Cc__fes /� c -. �� S 3� 75 <br />