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1 . SEWAGE I :'h' Connection necessary : Yes Nof_ <br /> Distance to Public Sewers <br /> Does existing septic system comply with Ord . #549 : Yes No_,_. <br /> Unknown If no, explain : <br /> Describe septic installation to 'be installed: <br /> 2 . FR afTEPLY — <br /> Is water supplied by pri7ate well : Yes Bio Is well Proper: <br /> Yes No State deficiency : <br /> Does existing or porposed use make tjxia hell public water: Yes <br /> I,,-<pxY_,,iNo `s" Sample of well T,ga*er taken' Yes No Date taken <br /> - <br /> Results Additional i-af rmation or comments <br /> 3 , <br /> Licensed scavenger pickup: Yes No � Service Area No. .,,� <br /> Other proposed disPoeal method=— <br /> Potential problem: <br /> 4 . EU M SQUITQ C7R_YT;�^Tt]R <br /> State possible vector potential & necessary control: <br /> 51 nILET/BATH EAaLL= <br /> No. & location existing: t1A Additional <br /> facilities needed--- <br /> 6 . <br /> eeded __...6 . E R E I Inn r. �Tc�� _ x M <br /> 7 . GENFFAL <br /> State say Problem: not previous?y noted : ,-4-, <br /> 3 . POPULATIQ14 DIU-1-T-1 <br /> APpx. No . People per 93q . <br />