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SK.SKWAGE <br /> Distance to Public Sewers Connection necessary: Yes No <br /> Does existing septic system comply with Ord. 3549 : Yes No_ <br /> Unknown If no, explain: <br /> Describe septic installation to 'be installed: <br /> 2. WATER SUPPr,X <br /> Is water suppliedby private well : Yes Nb'" Is well proper: <br /> Yee No State deficiency: <br /> k . Does existing or porposed use make this well public water: Yes <br /> No- Sample of well Water taken: Yes Na Date taken <br /> Results Additional information or comments <br /> 3 . <br /> Licensed scavenger up: Yee No Service Area No. <br /> Other proposed di osal method: <br /> IA Potential problem: <br /> 4. Z TnR PQj'PCNTIAL <br /> State possibpotential necessary control: <br /> 5. ZnILET/HATH EAOILUM <br /> No. & location existing: Additional <br /> facilities needed_______ <br /> G. PRFV OU LPCRATION HISTORY <br /> 7 . CaENERAL ,$6HjjATj0M <br /> State any problems not previously noted: <br /> P(7PULATI(?��,����''TT" <br /> Appx. No . People per <br /> 5 -514-"' � , ,� <br />