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f <br /> SRWAral <br /> Distance to Public Sewers '4" Connection necessary: Yes No '� <br /> Does ''lexisting septic system comply with Ord. #549 : Yeses No_ <br /> Unknown If 'no, explain: <br /> Describe septic installation to 'be i stalled: <br /> r d ar.�o1-d I' . 0 <br /> 2. WATER SUPEr,X <br /> Is Hater supplied by private well: Yes �'�o Is well proper: <br /> Yes No State deficiency:_ - <br /> Does e_x1sting or porposed use make this well public water,: Yes <br /> No..--:!� Sample of well water taken: Yes Ho--:::— Date taken <br /> Results Additional information or comments <br /> 3 . ears & REFUSE ; <br /> Licensed s avenger pick-up: Yes— No ervice Area No. <br /> Other propod diSP98al method: <br /> Potential pro lem: <br /> 4. ECTQa- P }'r Hj1AL <br /> , x State possible v tar potent iftl�(/necessary control: <br /> 5 . TTQTLFT/BATH FACILITEarX <br /> No. & location existing: Additional <br /> facilities needed <br /> 6. PHEYIc1R QPERATIQ TORY <br /> ? . ' <br /> State any pro leets not previously noted <br /> S . P02UL TTO DENSTTY N. <br /> Appx. Nol People per .act. mi. — <br />