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1. SEWAGE: <br /> Distance to Public Sewers: Connection necessary: Yes No <br /> Does existing septic syst comply with San Joaquin County Development . Title 4549 ? <br /> Yes No nknown If no, explain: <br /> Describe septic instal tion to be installed: <br /> 2. WATER SUPPLY: <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:IF jL <br /> s 01:1?Yy <br /> 3. GARBAGE & REFUSE: <br /> Licensed scavenger pick-up: Yes No Service Area No.: Other proposed <br /> disposal method: <br /> Potential problem(s): <br /> 4. FLY MOSQUITO OR VECTOR POTENTIAL: <br /> State possible vector potential and nec9_1_Wr61itr0l: <br /> 5. TOILET/BATH FACILITIES: Additional <br /> Number and locations existing: <br /> facilities needed: <br /> 6. PREVIOUS OPERATIO HISTORY: <br /> f <br /> 7. GENERAL SANITATION: <br /> State any problems not previously noted: f <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> r 16 <br /> Te- & NU�� `' h <br /> 2--o 0-7�_ 4ze� � T <br />