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IN 3 <br /> 1 • 5EWAGE <br /> Distance to Public Sewers e� Connection necessary: Yes No—V <br /> Does existing septic system comply with Ord . #549 : Yes No= <br /> unknown If no, explain: <br /> Describe septic installation to 'be installed: <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well: Yes No Is well proper: <br /> Yes No State deficiency: <br /> Does existing or porposed use mske thin well public water: Yes <br /> No Sample of well water taken: Yes Tho Date taken <br /> Results Additional information or comments <br /> 3 . GARB6GG ,, &__itEFUSE <br /> Licensed scavenser pith--up: Yes No Service Area No. <br /> Other proposed .disposal method: <br /> Potential problem: <br /> 4. FIx_M_OSbITLTQ_ OR_Y E^.TOR PO'j',ENTIAL <br /> State possible vector potential & necessary control : . . <br /> 5 . TOTLF.T/BATH FACTLITES <br /> No. & locution exioting! Additional. <br /> facil,i't :es 3rieeded <br /> 6 . PREYiQ6S OPERATTON HISTO t <br /> 7 . GENERAL FS) IT,S ATT-ONi <br /> State any problems not Previously noted: - <br /> 8 . <br /> oted 9 . POPULATIOU D c <br /> Appx. No . People per- eq,. .mi. � <br /> I <br />