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? ZSS _ 7 � � <br /> I <br /> 5VI <br /> Distance to Public Sewers Connection necessary: Yes No_ <br /> Does existing, septic system comply with Ord. #549: Yes No� <br /> Unknown I f no, explain: <br /> I � <br /> Describe septic installation to -be installed: <br /> r <br /> 2. E'ER SiTPPL'I <br /> Js w tom' supplied. b.� private well: Yes Na is well proper: <br /> yes__K Na State deficiency: <br /> Does a isting or porposed use make this well pub is Nater: Yes <br /> NoSample of well water taken: Yes No Date taker - <br /> Results Additional information or comments 7"/�.-eta ` <br /> 3 . GARBAGE & RFFUS� <br /> Licenaed scavenger pick-up: Yee No Service Area No.___.�. <br /> Other proposed disposal method: <br /> Potential problem: <br /> f <br /> 4 . IM"IQU P.QUISTIAL <br /> I State possible vector potential & necessary control: <br /> 5 . 10-ILEUBA.M. FACILITES <br /> No. & location existing: Additional <br /> facilities needed <br /> 6. PREV7CIM Q $X <br /> PZ <br /> 7 . GENERAL 5611118110 <br /> State any problems not previously noted: <br /> a . POELILAT f?DE SITv <br /> Appx. ?�o . People per q. mi. <br /> �� � IAI <br />