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SEWAGE <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 /> — f i <br /> 2. <br /> Is water supplied by private <br /> well ., lies _ Na 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 takers: Yes No Date taken ; <br /> Results Additional information or comments <br /> �} 4 y 5 <br /> L7 s <br /> Licensed scavenger pick-up: Yes No Service Area Na . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . 1 1.E yin =,ilt <br /> State possible vector potential & necessary control: <br /> 5 . <br /> Na. & location existing: Additional <br /> facilities needed <br /> 7 <br /> 6 . <br /> 7 . GENi n ` r -t+tr <br /> State any problems not previously noted: <br /> 6 . } NT TW <br /> Appx. No. People per sq. mi . <br /> S <br /> r <br />