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4 <br /> 1 . EESJAGTt ' ' 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 /> 3. - <br /> Describe septic installation to 'be installed: <br /> 2. WAT.EB..$lP ' <br /> Is water supplied- by private well: Yes "o— is Drell proper: <br /> Yes No State def+ciency:. <br /> Does existing or porposed use make this well public water: Yes— <br /> No Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> 3 . <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. FLY, EQSQUIT QR VECT02 EQ1r-j,'NTIAL <br /> State possible vector potential � necessary control: <br /> f 5. Tall-ETIBATHIACILITES <br /> No. & location existing: Additions]. <br /> facilities needed <br /> i <br /> 6. BERYT-09S r, O <br /> 7 . GENISBAT, SANITATION <br /> State any problems not previously noted: <br /> F S . Bf2pULATTQH DENETTv <br /> Appx. No. People per t3q. Mi. <br />