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G- <br /> Distance to Public Sewers Connection necessary : Yes_ No <br /> Does existing septic system comply with Ord . #549 : Yes_ No <br /> Unknown IE no, explain : <br /> Describe septic installation to be installed: <br /> Z. MATER SCIPPL'I <br /> Is Hater supplied by <br /> PP Private well : Yes L No_ Is well proper: <br /> Yes_ No_ State deficiency : <br /> Does e.)�Yating or porposed use make this well public Hater: Yeses' <br /> No L Sample of well Hater taken: Yes_. No_ Date taken <br /> Results Additional information or comments <br /> 3 . rARRA ,F & RriFCTS^ <br /> Licensed scavenger pick-up: Yes-Z No_ Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FLY MOSAU TO OR VR^TOR POTENTTA <br /> State possible vector potential Ri necessary control : <br /> ;1%H <br /> 5 . TOTLET/BATH UL <br /> No. & location existing: Additional <br /> facilities needed <br /> 6 . aRFVT�n rpr.RA ^rnrr HTeTne`� <br /> 7 . G'111ENFRAC. ;A�LITTATIL)v <br /> State any problems not previously noted : <br /> 3 . PnPtIL ATT Jt7 17 F`i'�TT`� <br /> Appx . No . People per 3q . mi . <br />