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Distance to Public Sewers Connection necessary : Yes <br /> Does existing septiNo_ <br /> c system comply with Ord . #549 : Yes No <br /> Unknown If no, explain: — <br /> Describe septic installation to be installed: <br /> 2 . HATER UM2 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 Na Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE R FUISF <br /> Licensed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method : <br /> Potential problem! <br /> 4 . FLY. MQ" .► TT() QR V Q ) Z2 .NT1A1 <br /> State possible vector Potentihl & necessary control : <br /> 5 • ZaILET/BATH AC'Ti T'1'�'^ <br /> No. & location existing: <br /> facilities heeded i " Additional <br /> 6 . PREVIQQS OPE26 T'TON HT. TCM <br /> 7 . GF.NF.RAT, SANTTA'TTC1N <br /> State any problems not previously noted: <br /> 8 . P 1P Ii,ATT�tp� DEN�TTY <br /> APpx . No . People per sq. rr,i .._ <br />