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Yes No_, <br /> 1• Public Sewers ConnectionOrd. 0549 , Ye8,L _ No— <br /> Distance to P Septic system comply with <br /> Does <br /> existing no, eXPlain: <br /> Unknown-- <br /> lation to 'be installed: <br /> Describe septic instalr ` <br /> 2 . waT R St1PPI,� Yes No._. Is wel Proper: <br /> •� r i v ate w e 11: 4'�/F•�.� <br /> Is wa er supplied b. p a p, <br /> Yes No State deficiencY� <br /> Daes istina or porposed use make this we' l P Dateataren`jeB <br /> NoSample of well water tO2jation or comments 2-���'`�` E <br /> Results Additional inf <br /> g , rARB GE RF lS , Yes. No Service Area No . <br /> Licensed scavenger pick-up: <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . ELY-�MOSc�UTTc� ORy Z^,TC1 pSt'f� MAIM TecessarY control - <br /> State <br /> ontral :State possible vector patentiftl <br /> 5 , TOTT�gT/BATH FAC STT ' Additional <br /> No. ec location :existing: <br /> facilities needed <br /> 6 . PPR+YIOUS OPERATION HISTORY <br /> d1 ,��.�o c� ,. ,-/ !`✓1���✓,I r9�A /�6Pi d.Ct/ice�-Co ,. <br /> 7 . GENERAL SAPTTTATTON <br /> State any problem not pre•;iotjBJy rioted. <br /> o � <br /> 8 . ECTI .A;Ton JFPj,,TTY <br /> Apex. No. Pea le <br /> P Per 6q, r,,1.��� <br /> i <br />