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1 . SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes No-o�- <br /> Does existing septic system comply with Ord. 0549 : Yes No_ <br /> Unknown If no, explain: <br />' Describe septic installation to be installed: <br /> 2 . WATER SIiPPL`� <br /> Is water supplied by private well : Yes No� Is well proper: <br /> Yes No State deficiency: <br /> Doe xistin$ or purposed use make this well public water: Yes <br /> No, Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> E 3 . <br /> Li e.nsed scavenger pick-up: Yes No Service Area No <br /> 0th proposed disposal method, <br /> Paten ial problem: <br /> 4. ELY ECTOR PQT=AL <br /> State I=ossib vector potential & necessary ntrcol: <br />' 5 , LQjLET/BATH--j1AQjLjTES <br /> No. & location existing : _ Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HI T <br />• <br /> 7 . OE.NERAL SANITAT_ a <br /> State any pl blems not Previously noted: <br /> Z' <br /> 8 . 1? QH DENSITY <br /> Appx . No. People per sq. mi . <br /> 4 <br /> k <br /> 1 <br />