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No vGsj <br /> 1 . SEWAGE A b • <br /> Distance to Public Sewers Ft '+' onnection necessary: Yes No— <br /> Does existing septic system comply with Ord. #549 : Yes No_ <br /> Unknown If no, explain: <br /> Describe septic installat on to be, installed: <br /> 1 rA.$ s / <br /> 22 <br /> r � <br /> Sc►7� Sdy,h4 vo. <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes Na Is well proper: <br /> Yes. No 1 State deficiency : <br /> tl�>- `e'as'4 04 P'i4fi e"sAgo, <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 No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . L MOSQUITO QR VEQTQR PS rLETIAL <br /> State possible vector potentiftl & necessary control : <br /> 5 . TO , .T/ ATH FACILITES <br /> No . & location existing : _ Additional <br /> facilities needed _ <br /> 6 . PREVTOT12 OPERATION HISTORYj) <br /> 7 . GENERAL SANITA`1'ION <br /> State any problems not previously noted : _ <br /> 3 . POP 1LATIO14 DEUTTv <br /> Appx. No . People per rq. mi . <br />