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1. S-RWAGEConnection necessary: Yes No._.., <br /> Distance to Public Sewers <br /> Does existing - septic system comply with Ord . #549 : Yes No_ <br /> Unknown It no, explain: <br /> i <br /> Describe septic installation to 'be installed: <br /> 2 . 7p <br /> Is water supplied- by Private well: Yes iso Is well proper: <br /> Yes NO State deficiencY' <br /> Does existing or pornosed use make thus wej�opubllDateatakenje� <br /> No Sample of well <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. ,QTQ ?n,rrNTjAL <br /> State possible vector potential necessary control: <br /> 5 . T0TLETj)3ATTL.FAQTLTTEra <br /> No. & location existing: Additional <br /> facilities needed <br /> 6 . BEgyTona OPERATTOM HLaT-01M <br /> 7 . QRS �' n <br /> StaREAL te any problems not <br /> pre•riouslY Hated: <br /> g'1 1 5 T v <br /> Appx. No . People per aq. mi. <br /> 3 <br />