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Distance to Public Sewers <br /> nnection necessary: yes N _ <br /> Does existing septic system comply with Ord. #949 : Yes No_ <br /> Unknown If no, explain: <br /> .Describe septic installation to be installed: <br /> Is wat supplied by private well : Yes No Is well proper: <br /> Yes No State deficiency :_ <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 /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method- <br /> Potential problem: <br /> 4. ELS a' R ULIAL <br /> State possible vector potential & necessary control : <br /> 5 . CTT,jTE$ <br /> No. & location existing: Additional <br /> facilities needed <br /> 6.. Mylorus 0 ERATION E==y <br /> r <br /> 7. GEN RAT. SANI`1"A'1'Tn�t <br /> State any Problems not previously rioted : <br /> 8 . PO UL T WIL-MiSITY <br /> Appx. No . People per rig.. mi . __�__ <br />