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Distance to Putlic Sewers -- Connection necessary: Yes-__ No_ <br /> Does exist ng septic system comply with Ord. 0549 : Yes--- No— <br /> Unknown---- it no , explain! <br /> Describe sepLic installation to be installed: <br /> 2 . H A I Z R-Z 11 UT,-Y <br /> Is water supplied by pri7ate well : Yes No--- Is well proper: <br /> Yee— Nr-,­ State deficiency - <br /> .......... <br /> Does existing or porposed use make this well public water: Yes---- <br /> Nn Sample of Poll water taken: Yes— No Date taken <br /> Resulta—­— Additional information or comments <br /> 3 , ULaUM"LA-2EME <br /> Licenued scavenger pick-up: Yes— No Service Area No. <br /> Other proposed disposal method:_— <br /> Potential problem- <br /> 4 . 2-Z2 M=AL <br /> State poazible vector potential & nacaszary control: <br /> No . & locatOn tills Additional <br /> facilities needed---­-------- <br /> 6 . <br /> 7 . <br /> not proviously <br />