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Distance to Public Sewers Connection necessary: Yes No,, <br /> Does existing septic system comply With Ord . #549 : Yes No_ <br /> Unknowin - If no, explain: 4 <br /> Describe septic installation to 'be installed: <br /> 2. 4�,p,LT E R S tI7�ET,� t <br /> Is Nater supplied. by private well : Yes � No Is well proper: <br /> Yes L No State deficiency: <br /> Does isting or porposed use make this well public Water: Yea <br /> No!zSample of well water taken: Yes No� Date taken <br /> Results Additional information or comment8.���p1 �P <br /> s e >- le.111 <br /> 3 . GARBAGE & REFUSR <br /> Licensed scavenger pick-up: Y No Service Area No. <br /> Other proposed disposal ;net <br /> Potential problem: <br /> St to possible vector potential As necessary control: <br /> r Td <br /> • f <br /> 5 . TOILET/BATH TACIL,I,TE <br /> No. & location exiting: Additional <br /> facilities needed <br /> 6. BEEVTOUS OPERATTQU HISTORX <br /> 7. GENERAL SAjjj j :C jQ0 3 <br /> State any problems not previous1y noted : <br /> 8 . pn [1�I014 DEYSLTY <br /> Appx. No . People per sq. mi. <br />