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Distance to Public Sewers Connection necessary: Yes No— <br /> Does existing septic system comply with Ord. #549 : Yee No— <br /> Unknown If no, explain: _ <br /> Describe septic-Installation to -be installed: <br /> Z. WATER-ai1nPL`I <br /> Is water supplied by private -cell ! Yes No Is well Proper: <br /> Yes No State deficiency: <br /> Does existing or porposed use make this Well public water: Yes <br /> No Sample of wall writer taken: Yes Na Date taken <br /> Results Additional information or comments <br /> Licensed scavenger pick--up: Yee No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . n OR VEQj02__PQ'fLHTJAL <br /> State possible vector potentifcl 8& necessary control: <br /> 5 . T!2111 Additional <br /> No . ez location exis ting :..��.-- <br /> facilities needed- <br /> 6 . P. 1 BE R A Z M' v <br /> 7 . A <br /> Stato any pro't)lems no-t previou ly rioted: <br /> ......:......... <br /> Appx. No . FeoD'.e per aq. s.�i . <br />