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f`4-A -M_ <br /> Distance to Public Sewers PClA Connection necessary: Yes Nom <br /> Does existing septic system comply with Ord. #549 : Yes_ No_ <br /> Unknown It no, explain: <br /> Describe septic installat on to 'be installed: <br /> 2. BASER SUPPL7 <br /> Is water supplied. by private well : Yes 14o Is well proper: <br /> Yeses No State deficiency: <br /> Does existing or porposed use make this well public water: Yes <br /> No Sample of well water taken: Yes bio Date taken <br /> Results Additional information or comments <br /> 3 . <br /> GARBAGE R <br /> Licensed scavenger pick-up: Yes-Z- No Service Area No . <br /> Other proposed disposal method: <br /> Potential prob?.em: 1?0­0 <br /> 4. S +^TO P01 + T <br /> State possible vector patential & necessary control: <br /> 5 . Or ^ f r LI T^ <br /> No . & location existing: tilp Additional <br /> facilities needed <br /> 6. BRFVTQQS r;pRRA: Q9 HISInRX <br /> C",(;If <br /> State any problems not pre•r; ouZ I? ro ted : 4i'vo <br /> 3 . P PtT 4mLr:tis .7 ofTv <br /> 7� fl t 1 <br /> App: . No . ?:' :p�a p?r 3Ci L._' <br />