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A <br /> Distance to Public Sewers L� Connection necessary: Yes No— <br /> Does existing septic system comply with Ord. 0548 : Yes No <br /> Unknown If no, explain: - <br /> Describe septic installation to 'be installed: <br /> 2. (SUPPLY <br /> Is water supplied- by private well: Yes NO <br /> Is well proper: <br /> Yes_ No State defyciency: <br /> Does existing or porposed use make this Well public crater: Yes_ <br /> No Sample of well water taken: Yes No Date taken <br /> Results. Additional information or comments <br /> u <br /> 3 . <br /> Licensed seavenaer pick-up: Yes No. Service !fres No. <br /> Other proposed disposal met od: <br /> Potential problem: <br /> State possible vector potential. & necessary control: <br /> 5 . r <br /> No. & location existing: Additional <br /> facilities needed <br /> 6 . EHgyTona QERRAITOM HTSIORY <br /> cX►. 1t&4 &goa- <br /> 7 . GENERAL SANTIAITON <br /> State any problems not previously noted: <br /> 3 . MULATTO DRHBTIX <br /> Appx. No . People per eq. mi. <br /> r <br />