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Distance to Public Sewers Connection necessary: tee-- No_ <br /> Doea exl6ting stPtic system comply with Ord . 0549 : Yes— No— <br /> Unknown—_ n", exPlain- <br /> .......... <br /> Describe yePtic installation to "be installed: <br /> 7 <br /> in <br /> 77777 <br /> 2 . <br /> R SUPPLY. <br /> — W_ well : Yes -no— Is well proper: <br /> Is w1jej supplied by private <br /> Ye o,,, State deficiency : <br /> Does existing or porpoued use make this well public water: Yee <br /> Sample of wall w9ter taken : Yes_ Nojf� Date taken <br /> ddltianal information or comments <br /> Lican3eQ acavwnjar ;jet-op : Yes_ No m1 Service Area No . <br /> Othx. <br /> er <br /> Potential <br /> 4 . <br /> State pos3lbin vector potential necessary control : <br /> ee <br /> ------------- <br /> No . & location Additional <br /> _17------ <br /> v,� <br /> 7 , <br /> State any problemn not previously noteQUI X7, <br /> Appx . No . People Y-r q7m. <br /> elf I, <br />