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i <br /> Y <br /> 1. SEWAGE: <br /> Distance to Public Sewers: All Connection necessary: Yes No <br /> Does existing septic system comply with San Joaquin County Development Title 14549 ? <br /> Yes_� No Unknown If no, explain: 1 54- + 1-20' LL - oeQ D 04— <br /> Describe <br /> 4- <br /> Describe septic installation to be installed: <br /> 2. WATER SUPPLY: <br /> Is water supplied by private well: Yes_ No Is well proper: Yes _No <br /> State deficiency: t�aw�esa�� wt-e l'i's wfa- <br /> cr b — <br /> Is well system a Pu lic Water system?Yes No' Is the permit current? Yes o <br /> Does existing or proposed use make this well Public Water: Yes No Is water/w� <br /> sampling current: yes No Additional information or comments: <br /> 3. GARBAGE & REFUSE: <br /> Licensed scavenger pick-u Yes _No ice Area No tie`proposed <br /> P y <br /> disposal method: ��.U- t6P S//�^"� u�t�'y1 a t fin' <br /> Potential problem(s): a$ .L` <br /> 4. FLY MOSQUITO OR VECTOR POTENTIAL: <br /> State possible vector potential and necessary control: fj/ljam u-/ t Q.Pti i <br /> 5. TOILETBATH FACILITIES: r <br /> Number and locations existing: �7� pest nq k�d��tbP� t� Additional <br /> facilities needed: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> STD, Lpny�. � <br /> 7. GENERAL SANITATION: <br /> State any problems not previously noted: a&\-e <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br />