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Distance to Public Sewers Connection necessary: Yes No_ <br /> Does existing septic system comply with Ord. #549 : Yes <br /> Unknown If no, explain: No_ _ <br /> Describe septic installation to be installed: <br /> 2. SCTPfSr' <br /> Is water supplied by private well : Yes No Is well <br /> Yes No State deficiency : proper: <br /> Does existing or porposed use make this well public water: Yes <br /> No Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments;-- <br /> 3 . <br /> omments;'3 . QARRAGE & REEtrSE <br /> . Licensed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method : <br /> Potential problem: <br /> 4 . EL � � 'MUZI L. <br /> State possible vector potential & necessary control : <br /> 5 . t' <br /> No. & location exiating: Additional <br /> facilities needed <br /> 6 . HTSTORY <br /> 7. GENUAL—aARIMM)A <br /> State any problems not previously noted:._._ <br /> Appx. No. People per eq. mi . <br />