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1 . SFWAQ£ <br /> Distance to Public Sewers 15'ti fr Connection necessary: yes_ Nom <br /> Does existing septic system comply with Ord. #549 : 'les✓ <br /> Unknown If no, explain: No_ <br /> 2U- Sd'I� <br /> Describe septic ins allation to be Installed:V -� <br /> w.l rtCac�.'{Zw a`F-'12.2 xrS y'7.r <br /> 2 . H TER SrrPPr Y <br /> Is wa� supplied by private well : yes � iio_ Is well proper: <br /> Yes_ No_ State deficiency: <br /> Does existing or porposed use make this well pubic water: les- <br /> No Sample of well water taken: Yes— No—✓ Date taken tires <br /> Results Additional information or comments <br /> s ca a- tK<s�� nw- cam Kti, 11 w4ic. tyr f 1vaKd,e.�f <br /> 3 . OARBAGF. & RftFRec <br /> Licensed scavenger pick-up : Yes---L' Ne Service Area No. <br /> Other proposed disposal method: _ n� <br /> Potential problem: <br /> 4 • FLY M04AOrT0 OR Vr'^Tnn Pnrrr <br /> IT <br /> State possible vector ptentinl & necessary control : <br /> 5 . TnIL.F.T/BATH FA('It 7TF^ <br /> No . & location existing: F-x�s-h <br /> facilities needed --T Additional <br /> 6. PRFVTAR" nPMDATTnl1 ur^ rnnv <br /> I • S'xEI3ERAr. ^ArrrTA'fTC)N <br /> State any problems not previously noted: <br /> 9 . PQPUr.ATTor7 ny^7Ty <br /> Appx. No . People per eq . mi . <br />