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3 S- ^`yam is 9 d G►�,1�- ,� . �y <br /> 1 . SEWAGE /'s,olemac. -•C M/'6 vP.y, i7 /i -es .h 7 n/. /'ffa► . <br /> Distance to Public Sewers // Connection necessary: Yes No-z' <br /> Does existing septic system comply with Ord . 11549 : Yes No_ <br /> Unknown If no, explain: <br /> Describe septic installation to *be installed: <br /> 2 . MATER SUPPLY <br /> Is water supplied by private well : Yes V No Is well proper: <br /> Yes No State deficiency : <br /> Does existing or porposed use make- this well public Water: Yes <br /> Na Semple of well water tarsen: 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 . ELj,_ MOSQUITQ OR VV Z^TQZC)rLVTIA.TL <br /> State possible vector potentiftl & necessary control : <br /> 5 . Tri ,TT/ ATF_ I FACI ,I 'FS <br /> No . & location existing : Additional <br /> facilities needed _ <br /> 6 . PREV1002 OPERATION H S <br /> 4&—�— <br /> f <br /> 7 . GRN ERAL SA1UjA 'I(�N <br /> State any problems not previously rioted : _ <br /> S . P2L 1LATION ISE'ISTIv, <br /> Appx . No . People per sq . mi . <br />