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/Vv UG$� ycGor�rh� -� bU Ouy9 0� <br /> 1 . SEWAGE <br /> Distance to Public Sewers 4 Connection necessary: Yes No x <br /> Does existing septic system comply with Ord . 0549 : Yeses_ No_ <br /> Unknown If no, explain: <br /> �1'u apOL-e r °1v a <br /> 04wi l l N of h� a ~ ? a f ✓ /r . <br /> Describe septic installation to •be installed: <br /> 2 . WATER SUPPr,Y <br /> Is water supplied by private well : Yes No Is well proper: <br /> Yes No State deficiency : / / 21/1 <br /> / lbj'\ h�S 4 vee_ OA 6� CY6Ws�L L� `LI- i S 2,-L)op�z . 21/1 noL !.2&J�O/G�°9Y 1/ke . <br /> i <br /> i <br /> Does existing or porposed use make this well public water: Yes <br /> INo ` 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: 1/r (``a n- <br /> 4. <br /> ---4. =.,._ Q� : =C� ORy r^T(') PS)'rl 1 <br /> State pc;tiaible vector Potential & necessary cont rol : <br /> 5. TOILET/BATH FACILITES <br /> No . ez location existing : Addition��l <br /> facilities needed _ <br /> 6. , PREVTOTIS Q FR.ATION HISTORY <br /> 7. GENERAL SAIJITA`1'L <br /> State any problems riot previously noted:. � r Ni lGr <br /> 8 . F'OPULATIOId DE iISTjv,. <br /> Appx. No . People per eq. rr,i . <br /> / <br /> - viwesf. 6,t ' 50044, 0-r- 4orrSte- 1',1belwe� -k hOlySe . Cd <br /> 7-- //;- UC-a Gl l CGIu°y �/ bay v�S 1�?S�G� ' rG kdus e <br /> 3, Pa�+�s � 1cG�l vS�d env lv <br /> y. Z'•�'/, lf.���v// GJ'dtt C�'1NlIIG��`• 6h�c/ ((GI�� U�I�frfi 1NSGU SPl1 <br />