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Distance to Public Sewers Connection necessary: Yes No <br /> Does existing septic system comply with Ord . 0549 : Yea No_ <br /> Unknown_ If no, explain: <br /> Describe septic installation to 'be installed: <br /> e... <br /> 2 . <br /> Is water supplied by private well : Yes No— Is well proper: <br /> Yee "'Ido State4c-fancy: <br /> Does existing or porposed use make this well public water: Yew <br /> No Sia of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> 3 . �3AG �i REl?CfSP� <br /> Licenced scavenger pick-up: Yes .,,. No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem- <br /> 4 . <br /> roblem:4 . FLY,, MOOfjTT4 C7 V _PC .TT.IAL <br /> State possible vector potential & necessary control: <br /> 5 . TOILFT/BATH ZAQt <br /> No . & location existing: _.___..__ Additional <br /> facilities needed_ <br /> 6 . P$ ylt S nPE j()U iiI�-T��Y <br /> } p ,. <br /> fJ ) J <br /> F; <br /> 7 . <br /> State any problems not previously noted• <br /> 8 . 115 <br /> Appx. Eo . People pear sq . mi <br /> F <br />