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SHWAU .'t <br /> Distance to Public Sewers Connection necessary: Yes---..,,No' s <br /> Does existing septic system comply with Ord, #549 : Yes No_ <br /> Unknown If no, explain: <br /> Describe septic installation to 'be in talled: `' 'L'DvA 1.11 <br /> � r Bcr <br /> 2 . WATER S[ EELY <br /> Is water supplied: by private well: Yes No Is well proper: <br /> Yes No State deficiency: <br /> Does existing or porposed use make tilis well public water: Yes <br /> No Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> nA <br /> 3 . <br /> Lic reed scavenger pick-up: Yes No Service Area No. <br /> Othe proposed disposal method: <br /> i <br /> Potent al problem: <br /> 4, -Itj E,^Ton Pa�r.ENTTAL <br /> State pons ble vector potential RA necessary ca rol: <br /> 5. TOILET/BATH FA <br /> No. €i location ex i ting: Additional <br /> facilities needed - <br /> 6 . PREYTOU8 <br /> OPERA- <br /> 7 . <br /> State any prob . ms not previously noted: ` <br /> 4 <br /> Appy. No . People per.-..sn. mi _. <br /> i . <br />