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I . EEWAGF� <br /> Distance to Public Sewers /.�`' Connection necessary: Yes No.� <br /> Does existing septic system comply with Ord . #549 : Yes-Z No_ <br /> Unknown If no, explain: <br /> dr ��6 da.�,�,L�-„ d ,G�� ✓r.✓f•6 �° c., e, o Fit�s dF%�6 ✓fo��.rw''�'.✓� <br /> Describe septic installation to 'be installed: &;% <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : ,/, Yes Nom Is well proper: <br /> Yes NoT State clef ieiency : F� <br /> 9�s'1 �/P'�9�F l✓F•GG �./�c��s r�✓fd F..0 .�1 c �'.d�/ � d FrC .Z Pa d��,�/,� <br /> �o t'q�F ,e�9 ce����/�i�F�F��e��9��F✓ ice/�✓E�,., <br /> Does existing or porposed use make this well public water: Yeses_ <br /> No Sample of well water taken: Yes No -/ Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE, & REFUSE <br /> Licensed scavenger pick-up: Yes -r No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . Fa,_ MOSQUITO OR VECTOR PO f=AI.L <br /> State possible vector potentiitl Pz necessary control : <br /> 5 . TOTLET/BAS FACILITES <br /> No . & location existing , �� — Additional <br /> facilities needed _ <br /> 6 . PREVIOUS OPERATIO14 HISTORY <br /> � /z <br /> 7 . GENERAL SA I'rAlS��N <br /> State any problems not previously noted: ��� -�"� �'�-�•�-e� <br /> � � �r ' •�>`�./' Qom'' <br /> 3 . POPULAyTIOP4 Dr t43TjY <br /> Appx. No . People per cq . <br />