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i' Distance to Public Sewers�R i Connection necessary: Yes No <br /> Distance <br /> Does existing septic system comply with Ord. 1549 : Yes No_ <br /> Qnknown�_ If no, explain: <br /> Describe septic installation to 'be installed: <br /> Z . MATER SURELZ <br /> Is water supplied. b9 private well.: Yes 'L40L Is well proper: <br /> Yes No State def ici*ncy <br /> Does existing or porposed use make this well public water: Yes <br /> No- Sample of well water taken: Yes No Date taken <br /> Results_ Additional information or comments <br /> 3 , aARRAQ7 & REET <br /> Licensed scavenger pick-up: Yes No Service Area So. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 Rr,T- -MOSQUITO OR TTCTQ2 RCTEEMT A r <br /> State possible vector potential & necessar, control: <br /> 5 . TO TT.F T/BATH TACTL 7TFS Additional <br /> No & location ex"s ting: <br /> facilities needed <br /> 6 . PRE�jT(�fSS c'PrRA'"T�t� T�Tt��`T <br /> 7 . C,F.NFgA7, SAHTTATTON <br /> State any problems not pr eviotlz 1. noted: . <br /> *annrTT,AT'T�ij nr'42 <br /> S • apn:Y. No . L eop le per 3q. mi. <br />