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Distance to Public Sewers Connection necessary: Yes No <br /> Does existing septic system complY with Ord . 9549 : Yea= No— <br /> Unknown If no, explain: <br /> Describe septic installation to 'be installed: <br /> 2. WATER SUPPL7 <br /> Is water s plied. b:;, pri•rata well : Ye <br /> s L/ 1140 Is Well proper: <br /> Yes Edo 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 . CARBAGE & REFUSE / <br /> Licensed scavenger pick--up: Yes—,/No—No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem:,- <br /> 4. <br /> roblem:'4. FLY., MQ',VQUTjj2k^Tn n' , T <br /> State possible vector potential necessary control: <br /> n ;^ - T3 <br /> No. & location e:cisting: Additions) <br /> facilities needed � <br /> } <br /> 7. ZA07TTITTOtf <br /> State an,,, rroo.ieme not previous 1;r noted <br /> ' � . (� r;�• ^"fit- J - `* "'^+`,7 <br /> k <br />