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�.. AGR <br /> Distance to Public Sewers Connection necessary: Yes No <br /> Does existing septic system comply with Ord. #549 : Yes= No— <br /> Unknown It no, explain: <br /> (Cry'/ k <br /> Lclams -f n 1,e sem- arm r 3I "� +Describe septic installation to 'be installed:-_ --_ __--- - <br /> 2. SER [IS PPLY <br /> Is water suppliedby private well : Yes ��o Is well proper: <br /> Yes - No State deficiency: <br /> Does ex sting or porposed use make this well pie crater: 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. <br /> roblem:4. ELL MQ'SQUlTn QJ VECTOR. POTENTIAL <br /> State possible vector potential necessary control: <br /> a . n <br /> No. & location existing: Additional <br /> facilities needed. <br /> S. PRFyj0U$ GPrRATInN HjS2!nRX <br /> 7 . GENERAL 5ANITAITON <br /> State any problems not previously rioted: <br /> a . EMULATION DEMSTTY <br /> Appx. No . People per .c3q. mi. <br /> a <br /> 1 <br />