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Distance to Public Sewers /J Connection necessary: Yes No <br /> Does existing septic system comply With Ord. 3549 : Yes t7, No— <br /> Unknown . 1A no, explain: <br /> I-_ r1s.. la c 1774eld --;CIPA <br /> Describe septic instal ation to 'be installed: ] I �r1!/-��.T/- �8'T� f <br /> O *C <br /> 2 . WATER,50p 7 <br /> Is water ' supplied. by private Well. Yes -�No is fell proper: <br /> Yes �o . State deficiency: <br /> Does e sting or porposed use make this well Pu a water: Ye <br /> No Sample of Well Tater taken: Yea No Date taken <br /> Results Additional information or comments <br /> G.uas c�K.C.C.7LZ w- CO e--f-crAjA <br /> Licensed scavenger pick-up: 'yes - No Service Area 'No. <br /> Other proposed disposal method: - <br /> Potential <br /> ethod: _Potential problem: <br /> 4. ELY. MQSQQjTQVECTOR Fnr rr <br /> State possible vector pate tial necessary control: <br /> e <br /> 'aa <br /> i <br /> ZArTr.jTT5, <br /> No. & location existing: Additional <br /> 4 facilities needed --6 . PgEvTnna OPTRATTOU HISTORM, <br /> .S <br /> State an,V LroQ.iems no-t prer:'0=17 noted: <br /> TF! •rn rmV <br /> No . <br /> S ul- <br />