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1 " Connection necessary: Yee No <br /> c � <br /> Distane to'- Seders - with Ord. 9549 : Yes No_ <br /> Does existing �$Ptic system comply <br /> Gnknown It no, explain= / <br /> a <br /> Describe septic installation to 'be installed= <br /> WATER 1FPPT.7 - i C Zs wee l proper: <br /> Is water suWlied• b.r pri7ata ge4 <br /> Yes Rv State ds�+ci_ncY: <br /> //� <br /> Does existing or PorPoaed wee make this well _pubI)a_teatakenTe— <br /> Ncr_ Sample o-fwell water taken: Yes____ No_ <br /> ResultsAdditional in2ormation or comments <br /> 3 . Service- Area No. <br /> Licensed scavenger - P Ck-uP: <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4, <br /> MOSQUITO ^Tn ?Q13ILT—TAL <br /> a <br /> State Possible vector Potential a necessary eQntrol: <br /> S , n r r r TF.^ Additional <br /> iio . & Location eYistin8 <br /> facilities' needed <br /> I <br /> 7 . » ­gAr, IA?TTTATTnR State an;r problems not pre•TiQusy�_? nOtad : <br /> -Pn 11 'r T T it n` `" >'�v l <br /> S pn oto . L eflp 1A per act mi. <br /> i� X <br />