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.. SRIIAUEt <br /> I <br /> Distance to Public Sewers Connection necessary: Yes No <br /> Does existing septic system comply with Ord. #549 : yes No— <br /> Unknown— If no, explain: <br /> Describe septic installation to 'be installed: <br /> i <br /> 2. WATER S aPPI <br /> Is water supplied. by private well: Yes No Is well proper: <br /> Yes No State def;cieney: <br /> i <br /> i <br /> ' h <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 . S ,CTOR EQ'CEHTTAT, <br /> State possible vector potential. & necessary control: <br /> 5 . n T ^ <br /> No. & location existing: Additional <br /> facilities needed <br /> 6. EaRvioaa-a2EHATLM 1JISIM <br /> 7 . r n <br /> State any problems not prevso«sly noted: <br /> 3 . f f 1,T T d 'j;,ZjS T TV <br /> Apex. h10 . Pe::p,e per sq. mi . <br />