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2 . SEWAGE i <br /> Distance to Public Sewers Connection necessary: Yes No <br /> Does existing septic system comply with Ord. 1$549 : Yes No_ <br /> Unknown If no, explain: <br /> Describe sept installation to 'be installed: <br /> 2 . WATER SUEPLY <br /> Is water supplied. by Private well: Yes No Is well proper: <br /> Yee No State deficiency: <br /> Does existing or porposed use make this well public water: Yes <br /> No Sample of well water taken: 'Yes No Date taken <br /> Results Additional information or comments a2na <br /> 3 . <br /> Licensed scavenger pick--up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: .. <br /> 4 . E'erMQSQUI:[Q QR-VE-,,TOR ou-NTIAL <br /> State possible vector potenti.ftl & necessary control: <br /> 5 . TQ 9 <br /> No. & location existing: Additional <br /> facilities deeded <br /> 6 . PREVIOUS ORERATIONS C] <br /> 7 . QENFRAL SAJITTATION <br /> State any pro'bl.ems of prevl.ously noted: <br /> 8 . F_QP12LATTON L EN25TTY <br /> Appx, No . People ger _a<j. mi . <br /> 6 <br />