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T <br /> 1. SEWAGE: . <br /> Distance to Public Sewers: V Connection necessary: Yes ✓ No k <br /> Does existing septic system comply with San Joaquin County Development Title 9549 ? <br /> Yes No . Unknown If no, explain: dt/_rv- "6F;Afls/E- <br /> . <br /> escribe septic installation to bei stalled: <br /> 2. WATER SUPPLY: C i9'L 40 A091'4 4V �v l <br /> Is water supplied by private well: Yes j/ No Is well proper: Yes No <br /> State deficiency: A/904( -/ Ca60ne-e" �^ - c- w�t,l�-G <br /> Is well system a Public Water system? Yes No Is the pe it current? Yes No <br /> N <br /> Does existing or proposed use make this well Public Water: Yes o Is water/well <br /> sampling current: yes No Additional information or comments: <br /> 3. GARBAGE & REFUSE: <br /> Licensed scavenger pick-up: Yes No Service Area No.: Other proposed <br /> disposal method: <br /> Potential problem(s): 1� <br /> 1C <br /> 4. FLY MOSQUITO OR VECTOR POTENTIAL: <br /> State possible vector potential and necessary control: <br /> 5. TOILET/BATH FACILITIES: <br /> Number and locations existing: Additional <br /> facilities needed: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> 1I <br /> 7. GENERAL SANITATION: <br /> State any problems not previously noted: <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br />