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SohG .o5f iI <br /> Dvi 106cl OS <br /> 1. SEWAGE: <br /> Distance to Public Sewers: Connection necessary. Yes No <br /> Does existing septic system comply with San Joaquin County Development Title 9549 <br /> Yes � No Unknown If no, explain: <br /> Describe septic installation to be installed: <br /> 2. WATER SUPPLY: <br /> Is water supplied by private well: Yes X No Is well proper: Yes �K 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 >C 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 /> 4 <br /> Potential problem(s): MKSt Ce:nq(-)Vf, j2,J 1 ,c�� -hr -k2 <br /> 4. FLY, MOSQUITO OR VECTOR POTENTIAL: <br /> State possible vector potential and necessary control: <br /> W <br /> S. TOILET/BATH FACILITIES: <br /> Number and locations existing: Additional <br /> facilities needed:' <br /> 6. PREVIOUS OPERATION HISTORY: <br /> I 7. GENERAL SANITATION: <br /> State any problems not previously noted: <br /> 8. POPULATION DENSITY, <br /> F <br /> Approximate number of people per square mile: <br />