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.. SHWAGE <br /> Distance to Public Sewers >rs2114 Connection necessary: Yee No ✓ <br /> Does existing septic system comply With Ord. #549 : Yes= No_ <br /> Unknown-M,cL f f-r no, explain: DLC,C, .tet;�� -71-014r <br /> � 71-ot(3 ZtaOSr r-(o,., �� • .v '� 42..o�G � <br /> Describe septic installption to 'be installed: <br /> 2. VATER SUPPLY <br /> Is anter suppliedby private we'll: Yes No Is well proper: <br /> Yes No State deficiency: <br /> Does existing or porposed use make this well public water: Yes <br /> No_ Sample of well water taken: Yes No Date taken <br /> Results Additional information or Ccomments <br /> s �vrtc'.S a v� [c"o V�tx-+ret <br /> 3 . AGE & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal. method: <br /> Potential problem. - - <br /> 4. FLY. MQSQUITQ OE YECTOR POTENTIAI, <br /> State possible vector potential & necessary control: <br /> 5 . MILE BATH„,EACILrte, <br /> No. & location existing: Additional <br /> facilities needed .__. <br /> 6. ERRyToraT QEER6TIQM HTSTQRX <br /> 7 . GENERAL..SANITATION <br /> State any problems not previously noted: <br /> 8 . EMLATTON DRNST11 <br /> Appx. No. People per aq. mi. <br />