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K W _r. -� <br /> Distance to Public Sewers Connection necessary: Yes No <br /> Does exis-ting septic system compl.Y with Ord. 0549 : Yes No� <br /> Unknown_ If no, explain: <br /> Describe septic installation to 'be installed: <br /> 2. WATER SMLY. r4 47 POr1670' r <br /> Is Water sup�lied`by pri•,rate well. : Yes Is Frell Proper: <br /> Ye s No a ncy:T� p j e—1 <br /> P2 rcpz <br /> ��j Fit�„,.t.e� GCA Qir �✓✓ 1 �1�J j- <br /> D, a sting or p posed' e ak til s well bli - water: Yes l tle 11 0A.. <br /> No Sample of well water taken: Yee Note taken <br /> R_ u to -Additional information or comments_ <br /> fiJ ' 42 6 L S <br /> 3 . /V �U P� �! �dr:�e"t�el <br /> Licensed scavenger pick-up: yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> E 4. FLY. MOSQU110 ^Tn P0' - T <br /> State possible vector potential necessary control: <br /> 5 . QTLFT C' r - F^ <br /> No . & location existing: Additional <br /> Facilities needed <br /> 6. OR^ CEERATTOU HISTORY <br /> State any, -,rob;--ms not previous.' ? noted : <br />