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Distance to Public Sewers Connection necessary: Yes No_ <br /> Does existing septic system comply with Ord . #549 : Yes No_..,,. <br /> Unknown If no, expla1 ,_ re, 7 i clay . <br /> Al v r r fie 5 <br /> Describe septic insta lation to -°be installed: <br /> z. HAT R <br /> Is wat supplied by private well: Yes ✓ No Is well proper: <br /> Yes L/- No S ; -ncy <br /> Does existing or pornosed use make this well public Water: Yes <br /> No- Sample of well water taken: Yes No Date taken <br /> Result$ Additional information or comments <br /> 3 . GAR AGE &FR us� <br /> Licenced scavenger pick--up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. FLI. MOSz 919 0 Vr,C TOMPOTENTIAL <br /> State possibly: vector potentirtl & necessary control: <br /> 5 . nTT.FTAA7v'ff FACTLUES <br /> No. Fc to ation exist;)?g: Addi onal <br /> facilit s needed <br /> 2,2- <br /> 6 . PR RY-T-O TS CErM�1 1 T aTCI$X <br /> 7. GENERAL 5A1tITA.T <br /> State any problems not prevlouslY noted: <br /> Appx. No . People per req. mi . <br />