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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 If no, explain: <br /> Describe septic installation to be installed: <br /> 2 . WATER SUPPLY / <br /> Is water supplied by private well : Yes 4/ f10 Is well proper: <br /> Yes--L, o St -ciciencv <br /> ' to c C/ <br /> z <br /> Does existing or porposed use make this well public Water: Yes <br /> No Semple of well water taken: Yes No Date taken <br /> Results Additional information or comments �1Y <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up : Yes No Service Area No. <br /> Other proposed disposal method: _ <br /> Potential problem- <br /> 4 . <br /> roblem-4 . ESLjL MnSQU.LTO OR V Z^TQ1 P)fLNZT L <br /> State possible vector potentiitl Fz necessary control : <br /> 5 . TOILET/BATfi FACILITES <br /> No . ec location existing : — Additional <br /> facilities needed _ <br /> 6 . PREVIOUS_ OPER "' nil HT3,T.QRX <br /> - V <br /> 7 . RN FRAL EANIT,j'I()N /�- <br /> State any problems nr-)t previously noted .- - <br /> 8 . <br /> oted : _8 . I=)LATIC►t4 I►n'q,�p T I v <br /> Appx. No . People per rq . mi . <br />