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Distance to Public Sewers Connection necesF;ajy ' Yes— No— <br /> Does existing septic system comply with Ord . #1)49 -.- No— <br /> Unknown— If no, <br /> Desp ase tp is <br /> installation to be i-fttft-aJjj-ed , <br /> 2 2 <br /> '2. <br /> 2 . <br /> C20 <br /> SUIDIDlied bV 'e s W ,'P' r o pe r <br /> Is water yil : <br /> Ye'S13 <br /> NO St�Ate <br /> Does existing or porposed use make.: this we. P'u Ij I i o w--i t e r ye s <br /> No L i Dafe- taken <br /> — Sample: of wel] water taken ., yes e s <br /> Results-- Additional ififurmation or <br /> 3 . GARBAGE REF= <br /> Licensed scavenger pick-up ! Yes_ No__ Service Area No. <br /> Other proposed disposal method : <br /> Potential <br /> �- <br /> Stake Possible vector potei-.Lti�tl & necessary contrcl : <br /> 5 . E-1112-TIDA IH-1"Q 11TEa <br /> No. & location <br /> Addition.--tl <br /> facilities needed <br /> 6 . EREY-IOUS _CTERLTION Hj-aTQRY- <br /> 7 . <br /> State any problertjo� not Pre"ri-omsi-y' <br /> ....:.................<..:...... <br /> Appx , No . People per tntq . <br />