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Distance tQ Public Sewers Connection necessary: Yes— No <br /> Doce exist-Ing neptic system comply with Ord . #549 .- Yes_ No— <br /> Unknown—.-- fpm no . explain- <br /> Describe -4-,eptic JLnatallation to be installed.- <br /> 2 . 1P <br /> Is water supplic�d b:f private well : Yes 4,L-- No Is well proper: <br /> Yeo--L--- -No <br /> Does existinlryor porposed uec make this well public water- Yes— <br /> ado .,pSample- Of ��Clj ta'ken,- Yes— No Da e taken <br /> ices is �m Additional information or comments <br /> Licenced pick--i,p Yes <br /> No Service Area No <br /> Other prop r, mt;"1,h aj, <br /> I-,,— je, <br /> 4 <br /> State ;olio r potenti€tl necessary control: <br /> Additional <br /> fa�-Illties <br /> -JV I <br /> IMP11 6f� 7 <br /> 7il-11 I 41.1-T I <br /> -ioted : <br /> L pre,,i o Z I x oe <br /> r <br /> . ........... <br /> A p,, <br /> px, Xo ; Pe c p e <br /> c,,vw tlz <br /> ,4 <br /> ej C f4 <br />