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Distance to Public Sewers Does existing septic s stem Connect <br /> iori necessar <br /> I f no y comply with Ordy Yes Na <br /> explain : . #549 : Yes— No— <br /> Describe <br /> Describe septic insi;allation to be installed : <br /> ra�F <br /> 2• ITERS UP T, <br /> Is wa <br /> Nr <br /> supplied by private well : <br /> Yes No State c,e-Fi Yes -L` No <br /> ciency: Is well ProPer: <br /> Doe istin <br /> No g or Porposed use <br /> Sample Of make 'tl)ir well public water: <br /> Results Well water taken: es <br /> Additional information or cam�trentsDate taken-----. <br /> Ye <br /> 3 . Safl�SBAG� <br /> Licensed scavenger <br /> dispcsalktriet�iOdes <br /> Other proposed NO S <br /> Potential _ Service Area No. __� <br /> prOblen, <br /> 4 . FLY, -- <br /> State possie �IL.'To <br /> vectorLPS�T .NTj� <br /> POtent ihll <br /> tsssary c�YztrOl : <br /> T��LI,ET�BATu FAt„7 ,7���, <br /> No . & location eX,etiri�: <br /> facilities needed <br /> Additional <br /> 6 ' P.BEVIOUS CiAT+nnmT ,, 5T0 — <br /> 7 . ^ <br /> State a <br /> problems previously riOteci <br /> Y <br /> A Px. NO. Peor per r3q . <br />