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I. <br /> 1 . SFWAGR <br /> Distance to Public Sewers Connection necessary: Yes No_ <br /> Does existing septic system comply with Ord. #549 : Yee No_ <br /> Unknown If no, explain: <br /> Describe septic installation to 'be installed: <br /> 2. WATRR SUPPL7 <br /> Is Water supplied. by private well: Yes iso Ie well proper: <br /> `. Yes . No State deficiency: <br /> Doe existing or porposed use make this well public water4j)FIes <br /> No Sample of well water token: Yee ' No 'Date t-aken <br /> Results Additional information or comments <br /> 3 . <br /> ERSR <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> ' i^T0ZQ'rCNTTArj <br /> State possible vector potential & necessary control: <br /> S. n C 5 <br /> No. & location existing: Additional <br /> facilities needed <br /> R � � <br /> s. On r n S O <br /> T. O <br /> State anyroble 4 <br /> p m., not previously noted: <br /> 9 . n 1 rn v <br /> I <br /> Appx. No. People per .act. mi . <br /> i <br />