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1 ,-r Connection necessary: Yes No� <br /> SEWAGF <br /> Distance to Public Sewers <br /> Does existing septic system comply with Ord. 0549 : Yes 4" No_, <br /> Unknown f no, explain: <br /> ✓F,df c �..r fes- �"Fi�.Qi,P.a��,or� �o •at.�,:lF .�-�'E �j► �i-dfc y°F,�2f B� /�r/.0 <br /> Describe septic installation to be installed: <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes iso Is well proper: <br /> Yes No State deficiency : <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 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes -' No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FAL MOSQUITO QR V E^.TOS ZC)rjajTIA,14 <br /> State possible vector potential 8z necessary control: <br /> 5 . TOILET/BATH FACILITES <br /> No . & location existing : _ Additional <br /> facilities needed _ <br /> 6 . ?RF,VI0r>2 OpEgATIQ14 HTSTngy <br /> 7 . GENERAL SAPU ZL(_) <br /> State any problems not previously noted : <br /> 8 . 'n 1LATIQN DENSTIv,. <br /> Appx. No . People per sq. <br />