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Distance to Public Sewers Connection necessary : Yes No_ <br /> Does existing septic system comply with Ord . #549 : Yew_ No_ <br /> Unknown If no, explain: <br /> Describe 1septic i stallati n So b instal ed: <br /> ,�.� cUlrlr� <br /> 2 . WATER SUPI <br /> Is water supplied by private well : Yes No Is well proper: <br /> Yes No State deficiency : <br /> Does existing or porposed use make this well public water : Yes <br /> No�_ Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> 3 - 11' G_RBAGE "EF-USI <br /> pi <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> \ her proposed disposal method: <br /> Po', . ntial problem: <br /> 4 . EILY. ) RrY ' ES)'MMI.AL <br /> State p sible vector potential & necessary control : <br /> X <br /> 5 F Additional <br /> No . & location exi -ting : <br /> facilities needed <br /> /f <br /> 6 . n ,� <br /> 7 . �F'i�ERAL �ANTTATTO� <br /> State any probl s not previously not <br /> Appx. No . People per sc1. m� .------- <br />