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T <br /> •• %1RW ` Connection necessary: Yes No___„ <br /> Distance to Public Sewers <br /> r� Does existing septic systemoc mply with Ord. 0549c Yes No— <br /> Unknow <br /> o_._, <br /> Unknown If no, explain: ; <br /> i <br /> Describe septic installation to -be installed: <br /> lee <br /> 2. <br /> Is water supplied- by private well. : Yes No Is well proper: <br /> Yes No State deficiency: <br /> k <br /> Does existing or porposed use make this well public crater: Yes- <br /> No <br /> es Nom Sample of well water taken: es comments-- <br /> Date taken <br /> Results Additional information <br /> - I <br /> 3 . GARBAQE & REFUSE <br /> Lioensed scavenger pick-up: Yes No..,^. Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. `" n 'T ' <br /> State possible vector potential PA necessary control: <br /> 5• TOILETCATH EIACIT,110. Additional <br /> No. & locution existing: <br /> facilities needed <br /> 6. 09 r M <br /> t <br /> 7. , <br /> State any problems not Previously notad: <br /> a <br /> Appx. No. People per a9. mi. <br /> k <br /> u <br />