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l. SEWAGE- Connection necessary: Yes No <br /> Distance to Public Sewers: <br /> with San Joaquin County Development Title 4544 _ <br /> Does existing septic system comply <br /> Yes No Unknown If no, explain: <br /> Describe septic installation to be installed. <br /> Z. WATER SUPPLY: No 1s well proper: Yes No <br /> Is water supplied by private well: Yes <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 mare this well Public Water: Yes No <br /> Is waterlwell <br /> sampling current: yes No Additional information or comments: <br /> 3. GARBAGE & REFUSE: <br /> Service Area No.: Other proposed <br /> Licensed scavenger pick-up: Yes No <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: Additional <br /> Number and locations existing: <br /> facilities needed: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> 7. GENERAL SANITATION: <br /> State any problems not previously noted: <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br />