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t4 _0S_ <br /> 1. SEWAGE: fG� <br /> Distance to Public Sewers: Connectidn necessary: Yes No <br /> Does existing septic system comply with San Joaquin County Development . Title T5_49 ? <br /> Yes No Unknown If no, explain: <br /> Describe septic installation to be installed: <br /> 2. WATER SUPPLY: F�Fp"l T !� 5�pG25,7 Cx��, �Uly' Oav�sC-C— <br /> Is water supplied by private well: Yes ✓ No Is well proper: Yes No <br /> State deficiency: <br /> Is well system a Public 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: IVDT <br /> �.n �X ��At,l�j, ��05C — -c_-fl bN �.� �I�t� '1"�• <br /> 3. GARBAGE & REFUSE: <br /> Licensed scavenger pick-up: Yes No Service Area No.: Other proposed <br /> disposal method: <br /> Potential problem(s): <br />} <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 /> 7. GENERAL SANITATION: <br /> State any problems not previously noted: <br /> S. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br />