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1 . SEWAGE <br /> Distance to Public Sewers �`' Connection necessary: Yes No-. <br /> Does existing septic system comply with Ord . $1549 : Yes_ No <br /> Unknown If no, explain: <br /> ( 12--0,9 90 <br /> Describe septic installation to 'be installed: <br /> 77vk.1e <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes -�o Is well proper: <br /> Yes No State deficiency : <br /> Does pxisting or porposed use make- this well pu is water: Yes <br /> No Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> 3 . <br /> Licensed cavenaer pick-up: Yes No Service Are o . <br /> Other prop ed disposal method: <br /> Potential pr lem: <br /> 4 . �L Sc r ^'r PsMMIAL <br /> State possible ve tar potential necessarycontrol : <br /> 5 . TOTLFT/BATH FACT_LITFS <br /> No . & location existing: Additional <br /> facilities needed <br /> 6 . PREVIOPSOF- RATION HIS= <br /> 7 . GENERAL SATLITAI <br /> o <br /> State any prble s not previously noted : _ <br /> Appx . N91 People per req. mi . <br />