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Connection necessary: Yes No <br /> Distance to Public Sewers ..�...—. <br /> Does existing septic system comply with Ord. 0549 : Yes No_... <br /> Unknown If no, explain: <br /> Describe septic installation to 'be installed:- -" <br /> 2. WATER SUPPLY <br /> Is water supplied. by private well: Yes No"L�f Is Drell proper: <br /> Yes No State deficiency: <br /> Does existing or porposed use make tilis we'll public crater: Yes <br /> NoSample of well water taken: Yes No Date taken_._ <br /> Results Additional information or comments <br /> 3 . <br /> Lic sed scavenger pick-up: Yes No Service Area No. <br /> Othroposed disposal method: - <br /> Potent 1`a_ problem: <br /> 4. ELY--M05�UI nR VZQT j FS_yZr,R= <br /> State possibl\ector potentiftl & necessary control. <br /> r <br /> 5. MILETIRATH EACTLITES <br /> No. & location existing: Additional <br /> facilities needed <br /> $ . PREYTOnS -0-PERATIQU ELSTORY <br /> 7 . QENERAL SANTj!A:rjQH <br /> State ani, problem: not Previously noted:- <br /> 8 . <br /> oted:-8 . EOPULATIO14 PENSTTX <br /> Appx. No. People per sq. mi . � <br />