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1 . yS 1WA ? , <br /> Distance to Public Severs Connection necessary: Yes No <br /> Does existing septic system comply with Ord. #549 : Yes <br /> Unknown If no, explain: No_ <br /> Describe Septic installation to 'be installed: <br /> 2. WATER S[JPPr,Y <br /> Is water supplied by private well : Yes NO Is well <br /> Yes No State deficiency: Proper: <br /> Does existing or porposed use make this well public water: Yes <br /> No Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> 3 . GARBAG ' & R6FiISF <br /> Licensed scavenaer pick-up: Yes ` No Service Area No . <br /> Other proposed disposal method : <br /> Potential problem: <br /> 4 . Fr-y. MOSOUTTO nR Vl!.^TOR PO'['rNTTAt <br /> State possible vector potential is necessary control: <br /> 5 . TQTLF BATH �Ar r,rTFS <br /> No . & location existing: Additional <br /> Facilities needed <br /> 6 . PRFVI S O BRAT O ISTO <br /> 7 • GPM 'RAT, SANTTATTON <br /> State any problems not prevlously noted : <br /> 8 . POPp .A^ nN nTV=TTV <br /> APpx . No . People per eq . mi . <br />