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rf 3 d? <br /> 1. SEWAGE: <br /> Distance to Public Sewers: Connection necessary: Yes No <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: � �� 7- <br /> Is water supplied by pri ate well. Y s 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 <br /> esNoDoes 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 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 /> PREVIOUS OPERATION HISTORY: <br /> 7. GE TATI p'e ✓Csr� 2 %l �'t �� <br /> State any problems not previously noted: s-jka6 2 7177 <br /> S. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br />