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a <br /> S 3. <br /> Distance to Public Sewers � — Connection necessary: Yes No <br /> Does existing septic system comply with Ord. 1549 : Yes NQ <br /> Unknown — If no, explain: — <br /> Describe septic f.;tztAllat on to 'be insta 1 <br /> Z. WATTR SnpQr 7 <br /> Is water supplied. b:r privata sell: Yes iso Is well proper: <br /> Yes No State deficienc7 <br /> Does existing or porposed use make this well public water: Yes <br /> Nome Ssmp Le of well eater taken: Yes Noj:�, Date taken- <br /> Results Additional in_ormation or comments <br /> 3 . 9ARRAC7 & RFFRSZ <br /> Licensed scavenger pick-up: Yes No Sarvice Area No .. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . wr v M SL- fUTTO OR 7TCTOR 70TrNTTAL <br /> State possible lector patentieLi �1 necessar•� control: <br /> 5 . 'Tn T7,F*7/ ATR 'ACTT,TTF, �';,� Additional <br /> No . & location existing: <br /> facilities needed <br /> 6 . P1-RF7TnfTS c'pFRA'"Tnrl 3T STnR" <br /> !AtITTATTnK_ <br /> State any problem notpI�'T f Ott;:;T :20tad : <br /> Anna . L'o . L eop Ls per !3q . mi. <br />