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'7 K? <br /> Distance to Public Sewers Connection necessary: Yes— No <br /> Does existing septic system comply with Ord . #549 .- Yes— No, <br /> Unknown— If no, expiziln! <br /> Xl�� 7=) C LLW� <br /> 7-1 <br /> �be ............ T? <br /> -is4ewPt' fd Ina tA1:l:art1o:n:....tia(�-be: -installed: <br /> 2. 7/4 <br /> Is water aupp'Ued by prix ate well : yes 110 Is well proper: <br /> State deficiency - <br /> Does existing or Porposed use make this well public water: Yes.:es= <br /> NO-- Sample of well water taken: Yes— No Date taken <br /> Results_ Additional inforTnation or comments <br /> Liceneed scavenger Pick--Up: Yes--�- '-'No— Service Area No. <br /> Other Propoeed disposal. method : <br /> dc– T 7 "A'/ r; 7--, ;r <br /> _yFT.,rop rEET TA, <br /> _ZC <br /> State possible vector pejtenti�tl, &x necessary control- <br /> 5 . T 9 1 L U.4, ,,1=. Q,L <br /> No. & location exiotjijg - ____ Additional <br /> facilities <br /> '�-4�IVLLL <br /> C�15 <br /> 7 . <br /> Stato any prob" em- not previousj- <br /> y noted : <br /> I'-Q21 L A.Tj Q <br /> TTV- <br /> Appx . No M i <br /> lip <br /> Ar <br /> P <br />