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r �' �-7 <br /> �t <br /> -7- <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 /> 7e xv"r4q. <br /> 2 . t J <br /> MATER SUPPi�I <br /> Is water oupplied. 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 tarsen: 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. <br /> roblem:4• ELY, M05QUITOM VE,;Q2:QR PO'ZENTIAL <br /> State possibly: vector potential & necessary control : <br /> I <br /> k <br /> 5. TQTT-ETLBAT$_...EACILITES <br /> No. €c location existing: Additional <br /> facilities needed <br /> 7 . GENtRAL SANTTATION <br /> State any problems not previously noted: <br /> i <br /> i <br /> 3 . EQ0EUT,6TIQU DENSTTv <br /> Appx. No. People per .rq. mi . <br />