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Distance to Public Sewers 4A Connection necessary: Yes -„No)r <br /> Does existing septic system comply with Ord. #549: Yes No— <br /> Unknown If no, explain: <br /> 4 <br /> 70-23V 77-7” <br /> 4 <br /> Describe septic install tion to 'be installed: <br /> 2. WATER SUPPLY <br /> Is watgr supplied by private well : Yes �No— Is well proper: <br /> Yes ✓ No State deficiency: <br /> Does ,existing or porpoeed use make this well puu ric Water: Yes <br /> No Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> 3 . GAR' GE BEE11SE <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal. method: <br /> Potential problem: <br /> 4 . FLY, E=U j OR VMQTQR PQ'[r,,jJTjAL <br /> i State possible vector potential & necessary control: <br /> F <br /> 5 . TOILETCATH FACILITF <br /> No. & location existinS: Additional <br /> facilities needed <br /> 6. EREVTOnS r RRAIIQU HISTORX <br /> 7 . GENERAL ,SAt1TTAITON <br /> State any problems not previously noted- <br /> 8 . <br /> oted:S . F0PULAjj0M DRL13TTV <br /> Appx. No. People per sq. mi. <br />