P82269 Jericho Church RdLOCATION / OWNER
Date of Inspection — -2. —hS Reason for visit: Complaint
Number in family Routine Survey
� f
WATER SUPPLY: GARBAGE DISPOSAL:
Type ................. �� y
Approved .............
Unapproved...........
SEWAGE DISPOSAL: l
Type ................. S,7 iaad4.f7;
Defects.. ..... r7
MILK SUPPLY:
Source ...............
Average consumption..
(pts per person day)
HOUSING: /
Type of building.....
Number of rooms......
Screened... ........
(yes/no)
Method .................
FARM POND ...............
(yes/no)
PREMISES:
Clean...... .........
(yes/no)
REMARKS: "
SANITATION RECORD PRIVATE PREMISES 6ctS c—
Form No. 472 (Rev. 9/58) a.