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..//��. ► i i r <br /> 1• SRWAggIF` <br /> Distance to Public Sewers Connection necessary: Yes No._,.,. <br /> Does existing septic system comply with Ord. #549 : Yes No— <br /> Unknown— <br /> o_Unknown - If no, explain: <br /> Describe septic installation to 'be installed: <br /> 2. WATER SUPPLY OP, <br /> Is water,- supplied. by private well: Yes �No Is well proper: <br /> Yes—k—Yes-k-f No State deficiency: <br /> Does existing or porposed use make this wellPublic water: Yes <br /> No Sample of well Water taken: Yes Nq Date taken <br /> Results Additional information or comments <br /> 3 . <br /> Licensed scavenger pick-up: Yeses= No Service Area No.�.� <br /> Other proposed disposal met <br /> Potential probem: <br /> 4 , FT.Y. MQSGUTTO- QR VECIOR PUCESITAL CIO <br /> State possible vector potentifel & necessary control: <br /> 5 . EACILITES <br /> No. & location existing: Additional <br /> facilities needed <br /> 6. PRRVTOna QPER&ITON HISTORM <br /> 7. QENERAT, SANIIATTO _ <br /> State any problems not previously noted: <br /> 5 . nEH5TTY <br /> Appx. No . People per sq. mi. <br /> l <br />