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Distance to Public Sewers Connection necessary: Yes No_ <br /> Does existing septic system comply with Ord . #549 : Yes No_ <br /> UnknowIf no, explain: <br /> { n <br /> Describe septic installation to 'be installed: <br /> 2. MATER SUPPLY <br /> Is water supplied by private well : Yes No Is Viell proper: <br /> Yes No State deficiency: <br /> Does existing or pornosed use make this well public water: Yes— <br /> No­ <br /> esNo , Sample of Well water a •en: es N6 ate taken <br /> Results Additional information or comments S �t-.��• �:_�' <br /> c._ <br /> 3 . . <br /> / <br /> `� REFUSE <br /> . SE <br /> Licensed scavenger pick-up: Yrd//s o <br /> re-_f4 SIe'" <br /> rea No. <br /> Other proposed dispose etbe-, <br /> —71 <br /> pa+Antia7 problem:_ <br /> 4 . FLY. MOSOUT10 O .-YRQ.T2RPO'rCNTT_AL <br /> jit o sibl vector potential Fs necessary Aoqtrel• <br /> Trdep <br /> 5 . F �ITF <br /> No . & location existing: Additional <br /> facilities needed� <br /> 6. PREVIOUS C%P NRATInh HISTORY <br /> 7 . GENERAL �5 A N I IA' T()I, <br /> Stateany prot)lems not previously noted: <br /> L <br /> aiL <br /> s . PO LAl ON DEMaT Y .� <br /> Appm. Me. ^__ /1 <br />