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Distance to Public Sewers Connection necessary. Yes No ✓� <br /> Does existing septic system comply with Ord. 9549 : Yes No ✓ <br /> Unknown It no, explain: <br /> ... ._ �Vo K r SY-7 ..5 G !�s4evi-Is rVt S <br /> Describe septic installati n to 'be installed: <br /> 2. WATER SnPPI.'T <br /> Is uatsr plied. b;7 private well: Yes V/ No Is well proper: <br /> Yes No State deficiency:_ s c_wss- ca.iAtGtc <br /> .exisf <br /> Does a sting or porposed use make this well public water: Yea <br /> No ✓Sample of well grater taken: Yes Ho � 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, MOSQQTZQ ,-,-rO PCT , TT <br /> State possible vector potential necessary control: <br /> 5 . nr F r ty Tr.^ <br /> No . & location existing: Additional <br /> facilities needed <br /> 6. PRRVTOng nEERATTOM RTSTnRX <br /> State an;r rrob.ieme not prev'_ousr.y noted : <br /> 3 . e) *3T mT,;,13 <br /> 3pn:. <br /> 90 . ?,::?, e pe: sc <br />