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l <br /> 1. SEWAGE: <br /> Distance to Public Sewers: Connection necessary: Yes No�_. <br /> Does existing septic ystem comply with San Joaquin County Development Title #549 ? <br /> Yes No Unknown If no, explain: Atm <br /> escribe septic installation to be installed: <br /> 2. WATER SUPPLY: <br /> Is water supplied by private well: Yes No Is well proper: Yes No_ � <br /> State deficiency: 1,-Ca <br /> AF 10-e <br /> Is well systema ublic Water system? Yes No Is the permit current? Yes No <br /> Does existing or proposed use make this well Public Water: Yes No Is water/well <br /> sampling current: yes No Additional information or comments: <br /> 3. GARBAGE & REFUSE: <br /> Licensed scavenger pick-up: Yes No— <br /> disposal method: <br /> Potential problem(s): <br /> 4. FLY MOSQUITO OR VECTOR POTENTIAL: Of <br /> stale possible vector potential and necessary control: zA�- ,& <br /> S. TOILETBATH FACILITIES: <br /> Number and locations existing: Additional <br /> facilities needed: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> 7. GENERAL SANITATION: _ <br /> State any problems not previously noted: <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br />