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1. SEWAGE: Nn ?ffP ( � o� <br /> Distance to Public Sewers: 4V6 1�' Connection necessary: Yes- No <br /> Does existing septic system comply with San Joaquin County Development . Title #549 ? <br /> Yes No Unknown If no, explain: <br /> Describe septic installation to be installed: <br /> 2. WATER SUPPLY: OJ° <br /> Is water supplied by private well: Yes No Is well proper: Yes No <br /> State deficiency: Citi W tt y- <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: <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 necessary control: A)bh 6— ND-I�A i <br /> 5. TOILETBATH FACILITIES: <br /> Number and locations existing: u Vn A'tV f Ao0-1 d- f ro O- I Additional <br /> facilities needed: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> i <br /> 7. GENERAL SANITATION: <br /> State any problems not previously noted: d"n <br /> 8. POPULATION DENSITY: ' <br /> Approximate number of people per square mile: <br />