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r <br /> SFWArzE <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 be installed: <br /> 2 . WATER SOP= <br /> Is water supplied by private well : Yeses, No Is well proper: <br /> Yes� No State deficiency: +( <br /> tom , � .�'C.— �"��_�a=•{ 1 '"� �SL � R 'k�t <br /> Does existing or porposed use make this well public water: Yes <br /> Nom 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 /> TQ Y <br /> 4 . VEQ <br /> Stat6 passible ve` for potents • ewe ,ary control : <br /> # No. & location exists __ Additional <br /> facilities needed <br /> 6 . PREVIOUS OPER AT_IO <br /> 7 . CENJ+RAS; SANITA`]' <br /> State any proteans not p eviously noted: --� <br /> 3 . UPULAT ; DENSI= / <br /> Appx. No. People per sq. mi. <br />