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Distance to Public Sewers �!- - Connection necessary: Yes Nam" <br /> Does existing septic system comply with Card. #549 : Yes-- <br /> No— <br /> unknown If no, explain: <br /> Describe septi in 'tallation o be instaed: a� <br /> / a .� v <br /> 2 . WAIER- SURELY <br /> Is water supplied by private well : Yes No Is well Proper: <br /> Yes No State deficiency: — <br /> Does existing or porposed use make t1iis well public water: Yes <br /> No Sample of well water taken: Yea No Date taken <br /> Resu s Additional information or comments <br /> g , <br /> GARBAGE & REFT)SE. <br /> .Licensed scavenger Pick-up: Yes No Service Area No . <br /> Other Proposed disposal method: <br /> Potential problem: <br /> State Possible vector potential & necessary control: -Z,� -- <br /> No. & location existing . --4 Additional <br /> � <br /> facilities needed --- <br /> 6 . ERRVIQU <br /> 7 . <br /> 6�� <br /> f <br /> State any problems no <br /> previcitts7_y noted: <br /> g . ET N DEEBITY <br /> Appx. No. People per sq. mi <br /> i <br />