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f <br /> 1. SEWAGE: <br /> Distance to Public Sewers: �^ Connection necessary: Yes No <br /> Does existing septic system comply with San Joaquin County Development Title 9549 ? <br /> Yes No Unknown If no, explain: <br /> I ^ <br /> Describe septic installation to be installed: <br /> 4 <br /> 4) I.A) 6V 11464V A <br /> 2. 'V&ATER SUPPLY: <br /> Is water supplied by private well: Yes No Is well proper: Yes��No <br /> State deficiency: , <br /> Is well system a Public Water system?Yes No s the permit current? Yes No <br /> Does existing or proposed use make this well Public Water: Yes No is waterlwell <br /># sampling current: yes No Additio al information o 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 MOS UITO OR VECTOR POTENTIAL: <br /> State possible vector potential and necessary control: <br /> S. TOILETBATH FACILITIES: <br /> Number and locations existing: Additional <br /> facilities needed: <br /> 6. PREY10US OPERA ON HISTORY: <br /> J <br /> f � <br /> } 7. GENERAL SANITATION: <br /> I <br /> State any problems not previously noted: <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br />