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Y <br /> 1. SEWAGE: Connection necessary: Yes <br /> Distance to Public Sewers: /70 <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: �~ Is well proper: Yes No <br /> Is water supplied by private well: Yes No P P <br /> State deficiency: <br /> Is well system a Public Water system? Yes No Is the permit current? Yes-No- <br /> Does <br /> esNoDoes existing or proposed use make this well Public Water: Yes No <br /> Is water/well <br /> sampling current: yes No Additional information or comments: <br /> 3. GARBAGE & REFUSE: s Service Area No.:-Other proposed <br /> Licensed scavenger pick-up: Ye <br /> disposal method: <br /> Potential problem(s): <br /> 4. FLY MOS QUITO OR VECTOR POTENTIAL: <br /> State possible vector potential and necessary control: <br /> r <br /> 5. TOILET/BATH FACILITIES: 12 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 />