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1. SEWAGE: <br /> Distance to Public Sewers: Connection necessary: Yes ✓ No <br /> Does existing septic system comply with San Joaquin County Development Title #549 ? <br /> Yes No ✓ Unknown If no explain: N SSG Syss ..�i <br /> Describe septic installation to be installed: <br /> 2. WATER SUPPLY: ✓NU <br /> Is water supplied by private well: Yes No APl°i4 d' lIs well proper: Yes No <br /> State deficiency: (_;N4- <br /> Is well system a Public Water system? Yes No Is the permit current? Yes No A- <br /> Does existing or proposed use make jhis well Public Water: Yes No ✓ Is water/well <br /> sampling current: yes No A Additional information or comments: <br /> 3. GARBAGE & REFUSE: <br /> Licensed scavenger pick-up: Yes ✓ No Service Area No.: Other proposed 4 <br /> disposal method: <br /> Potential problem(s): <br /> 4. FLY, MOSQUITO OR VECTOR POTENTIAL: <br /> State possible vector potential and necessary control: <br /> S. TOILET/BATH FACILITIES: <br /> Number and locations existin): Additional <br /> facilities needed: �4 <br /> 6. PREVIOUS OPERATION HISTORY: <br /> S t 0 E- <br /> 7. <br /> 7. GENERAL SANITATION: <br /> State any problems not previously noted: <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> 1:14 06 06 Rev 1199 <br />