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NOTE: PULL ALL PERX—TS (SEPTIC, WELL, ETC...) AKE COPIES FOR FILE- <br /> 1. <br /> IEF1. SEWAGE: <br /> Distance to Public Sewers: Connection necessary: Yes No <br /> Does existing septic syste comply with San Joaquin County Development Title 9549 <br /> Yes No U? If no, explain: <br /> Describe septic installation to be installed: <br /> 2. WATER SUPPLY: <br /> Is water supplied by private well: YesseL 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: <br /> 3. GARBAGE & REFUSE: <br /> Licensed scavenger pick-up: Yes No—i-- 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: <br /> 5. TOILETBATH FACILITIES: <br /> Number and locations existing: Additional <br /> facilities needed: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> Snnd <br /> 7. GENERAL SANITATION: <br /> State any problems not previously noted: l�ab0 L,f NM kr ei 1-5 1'y <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> EH 06 06 Rcv 09 <br />