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4 <br /> 57 rA�?r <br /> Distance to ,-PuiAic Sewers Connection necessary: Yes— No— <br /> DoeB "existing <br /> (.septic system comply with Ord . #549 : Yes No� <br /> Unknown ' If no,, explain: - <br /> Describe septic installation to 'be installed: <br /> '749,,f, <br /> I 51 <br /> 2. HATER S[1PPi�1' �(� LtJ' �� . <br /> Is water suppliedby private well: Yee Na Is well proper. <br /> Yes No State deficiency: <br /> Does existing or porposed use make this well public water: Yes <br /> Nom,,. Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> 3 . <br /> Licenced scaven8er pick-up: Yes Service Area No. <br /> ' Other proposed disposal method: <br /> Potential problem: <br /> 4. ELY, QUITQ OB VECTQR PQTZHTlA <br /> State possible vector potential & necessary control: <br /> S . TOTLETZBATff MGM= <br /> No. & location existing: �� Additional <br /> facilities needed <br /> 6. PREVIOn5 QEERATT0 4 HISTORY <br /> r <br /> 7 . GENERAL SANITATION <br /> State any Problems not Previously noted: <br /> 9 . EDBULATIQU DENSTTX <br /> Appx, No.. People per .act. m i. <br />