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a <br /> P + <br /> w <br /> EjEWAGE <br /> Distance to Public Sewers Connection necessary' Yes Na <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 MP.LY <br /> Is wat r supplied by private well : Yes No Is well. proper: <br /> Yes7No States d.eficiencY: <br /> Does jexisting or purposed use Toake this well public water: Yes <br /> NoSample of well water taken: Yes No Date taken <br /> Res Its Additional information or comments <br /> . Lic sed scavenger pick-up: Yes No Service Area No . <br /> Othe proposed disposal method:_ - <br /> Potent al problem: <br /> State poses ble vector potential & necessary antral : <br /> 5 . TQI 'FT/BATH FACS I LrL 'E <br /> No. & location exiAing : __/ Additional <br /> facilities needed "K - <br /> 6 . PREVIOUS OPERATE , __H_LST <br /> Y . GENERAL-SANITATTON f <br /> State any probl e" not previously, riot <br /> 8 . PUT LATIO <br /> Appx. No . People per sq. mi . <br />