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1 <br /> 1 SEWAGF <br /> Distance to Public Sewers Connection necessary: Yes No— <br /> Does existing septic system comply with Ord. #548 : Yes No_ <br /> Unknown If no, explain: <br /> Describe septic installation to 'be installed: <br /> ,e�> e-V—i c5lt,a,� ��� Ao er rs 0 W 7 ALA 19re <br /> r <br /> 2. WATER EUPf.Y 7-h� a <br /> Is water supplied. by p ?� - tS' well: Yes No Is well proper: <br /> Yee No State deficiency: <br /> Does existing or porposed use make this well public mater: 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. FLIL ,�QUITQ QR YEQTQ]3 POTTIRMAL <br /> State possible vector, potential 8A necessary control: <br /> 5 . TQTT-ET/BATH +A-01LITE <br /> No. €c location existing- ,�� Additional <br /> facilities needed <br /> '. <br /> 7 . ---SAIJITAIJON <br /> State any problems not Previously noted : <br /> 8 . EMILATION ENSTIX <br /> Appx. No. People per .sq. mi . ��,.,.----- <br />