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SEWAGE, A G� <br /> Distance to Public Sewers Connection necessary: Yes X No_ <br /> Does existing' septic system comply with Ord. 0549 : Yes No— <br /> Unknown.-X ._ If no, explain: <br /> C, h Aw -encs.}- vim- %I At-49 Art taus MM ")/d riar.� <br /> Describe septic installation to 'be installed: �✓� <br /> F ir v-ce_ Z Mu dt of <br /> 2, WATER SUPPLY <br /> Is water supplied, by private well: Yes No X Is well proper: <br /> Yes No State deficiency: <br /> e, <br /> Does, <br /> Does, existing or porposed use make this we"1 public water: Yesz_ <br /> No " Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments (A) <br /> �a a�,� tells ars ✓ra�r�r >� tkc�fyr•- __... <br /> 3 . <br /> Licensed scavenger pick--up: Yes No Service Area No. <br /> Other proposed disposal method! <br /> Potential problem: W/2- A~ A&U,5 Aee <br /> 4. FLY. MOSWUITQ OR VECTOR E MNTIAIL <br /> State possible vector potentitel necessary control: <br /> AI <br /> 5 . TQTLFT/BATH FACTLITES <br /> No. & location existing: MIA. Additional <br /> facilities needed <br /> 5. EREVIOUS OPERATION HISTORY <br /> 7 . GENE$8L SANITATIQ2 <br /> State any problems not previously noted: <br /> 3 . O NzZTY <br /> Appx. No . People per ..act. mi . <br />