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r <br /> SRWAGE <br /> Distance to Public Sewers Connection necessary : Yes_ No-- <br /> Does <br /> o_Does existing septic system comply with Ord . #549 : Yes_ No_ <br /> Unknown If no, explain : <br /> Describe septic installation to be installed: <br /> 2 . WATER SUPPLY � ' 7 <br /> Is water supplied by private well : Yes �o_ Is well proper: <br /> Yes— No_ State deficiency : <br /> Does existing or porposed use make this well public water: Yes— <br /> No zl- <br /> lesNozl- Sample of well water taken: Yes_ No `s Date taken <br /> Results Additional information or comments <br /> 3 . AGE & REFUSE <br /> Licensed scavenger pick>W. Yes_ No_ Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. ELY. M0SAUTTf3 OR VRQTQR POTFNTTAT. <br /> State possible ve for potentirl & necessary control: <br /> 7 Co .�.p 5 �"✓ c c' rho T� /iKe i <br /> 7 h.-y e� A-0 T / <br /> 5 . TOILET/BATH ?ACI . TES TS <br /> No. & location existing: % Additional <br /> facilities needed <br /> 6. PRRVIOQS ORKRATION HISTORY <br /> 7 . GENERAL SANTTATTON <br /> State any problems not previously noted : <br /> 9 . POPU .AT Otj nENSTTY <br /> Appx. No. People per sq . mi . ,,/ <br />