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XWAG <br /> Distance to Public Sewers Connection necessary: Yes_ No_ <br /> Does existing septic system comply with Ord . 1549 : Yes_ No— <br /> Unknown If no, explain: <br /> Describe septic installation to be installed: <br /> Z. <br /> Is water supplied- by private well: Yes No_ Is well proper: <br /> Yes— No_ State deficiency: <br /> Does existing or porposed use make this well <br /> water: Yes <br /> No Sample of well water taken: Yes_ o <br /> Results Additional information or comments <br /> 3 . C "RRAGF & R6FnSE, <br /> Licensed scavenger Pick-up: Yes_ No_ Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . Fr,T . MOSGU Tp OR Z TOR PO'CLNTTAL <br /> State possible vector potentiaeee$$m'Y control: <br /> 5 . TnTT FT/HATH RA('TT,TTE Additional <br /> No . & location existing: <br /> facilities needed <br /> 6 . PRRVTOOS nprRATTnN{ aT4TORY <br /> 2 <br /> 7 . GfNFRAi SANTTATTnN <br /> State any problems act pre'rfou�=' noted : <br /> s . <br /> pnnrtr ATTot4 nF.NSTT" <br /> Apnx. No . People per aq . mi . <br />