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R <br /> ,I/I� � <br /> Distance# to, PuN is Sewers Connection necessary: Yes Nox <br /> Does exist" #iBseptic system comply with Ord. #549 : Yea V No— <br /> Unknown 4wf'�na, explain: <br /> i <br /> Describe septic installation to 'be installed:.- /Iw <br /> 2. WATER S[1pPLY - <br /> Is water supplied. by private well : Yes .. i10 Is well proper: <br /> Yes No State deficiency: <br /> fDoe existing or pornosed use make this crell public crater: Yes No= Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> 3 . 9A <br /> Licenaed scavenger pick-up: Yes No Service Area Na. <br /> Other proposed disposal method: <br /> Potential problem' <br /> State possible vector potential & necessary control: <br /> M 5 , TQTLET113ATEC N <br /> No. & location existing: Additional <br /> facilities needed. <br /> 6 . <br /> 4S?Q&1iA <br /> k 7 . <br /> State any problems not previously noted: <br /> i <br /> Appx. No. People per .sq. mi . <br />