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Distance to Public Sewers G Connection necessary: Yes_ No J" <br /> Does existing septic system comply with Ord. #549 : Yes— No_ <br /> Unknown <br /> � ✓ If no, explain: <br /> f�-2oa,e <br /> Describe septic installation to be installed: <br /> 2. WATER.R SUPPLY <br /> Is water supplied by private well : Yes /No_ Is well proper: <br /> Yes /_ No— State deficiency: <br /> DoesP-I' <br /> or porposed use make this well pub7�c water: Yes <br /> No ✓ Sample of well water taken: Yes_ No ✓ Date taken <br /> Results Additional information or comments <br /> 1,)ecj wc.# -fp 1G d. iGd • olot ueo n a-1-ke <br /> cl <br /> 3 . <br /> Licensed s avenger pick-up: Yes_ No_ Service ea No . <br /> Other propo d disposal method: <br /> Potential pro lem: <br /> 4. FLY ECTOR POTENTIAL <br /> State possible ve for potential & neces ry control : <br /> 5 . TOILET/BATH FACILTTES <br /> No. & location existing : _ Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HISTO <br /> 7 . GENERAL SANTTATT/N <br /> State any prob ems not previously noted: _ <br /> �. -- <br /> S . POPULATIO <br /> Appx. No Pe ple per sq. mi . <br />