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y. <br /> R y.. <br /> Distance to Public Sewers Connection necessary: Yes No <br /> Does existing. septic system comply with Ord. #549 : Yes No— <br /> Unknown If no, explain: <br /> Dt,acribe se 0 , e d:- <br /> 2. <br /> :-2. WATER SUVEr, � � <br /> Is Nate supplied bar private well: Yes No Is viell proper: <br /> Yes No State deficiency: <br /> Does, e or porposed use make this well pubic Water: Yes <br /> No Sample of well water taken: Yes Na Date taken <br /> Results Additional information or comments <br /> 3 . UARBAQT., jU_M <br />` Licensed scavenger pick--up: Yes..,_._. No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: , <br /> 4. F1�Y__;_._M0rS!LT2 OR Vj�`".TC-R PC1TIAWTIAL <br /> State possible' vector potential & necessary control: <br /> 5 . n Ur <br /> No. & location existing: �— Additional <br /> facilities needed. <br /> h 6 . P.HEvMCTS 201EERAI Ops HISTORY <br /> aaw <br /> 7. GENERAL SANITATION <br /> State any problems not previously noted: <br /> S . 2Q)EULATTON DEMaTTV <br /> Appx. No. People per .sq. mi. <br />