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i <br /> :P <br /> 1. SEWAGE: <br /> Distance to Public Sewers: I Connection necessary: Yes No <br /> Does a 'sting septic system comply with San Joaquin County Development Title #549 ? <br /> .-,Yes No. t,A ' Unknown If no, explain: <br /> Describe septic installation to be installed: <br /> 2. WATER SUPPLY: <br /> is water supplied by private well: Yes o 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 curre • yes No Additional information or comments: <br /> 0" <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 MOS UITO OR VECTOR POTENTIAL: <br /> State possible vector potential and necessary control: <br /> S. TOILETBATH FACILITIES: <br /> Number and locations existing: Additional <br /> facilities needed: <br /> 6. PREVIOUS OPERATION HISTORY: / <br /> w <br /> 7. GENERAL SANITATION: <br /> State any problems not previously noted: <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br />