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1. SEWAGE: <br /> Distance to Public Sewers: if//� Connection necessary: Yes No ✓ <br /> Does existing septic system comply with San Joaquin County Development Title #549 ? <br /> Yes No ✓ Unknown If no, explain: .4sS cel,¢�•y� 5�up 4,-6 ed&ec ,,o, <br /> .SE3°7ta �� / iicrLc 4 � 2v <br /> :2 —" j <br /> Describe septic installation to be installed: <br /> 2. WATER SUPPLY: <br /> Is water supplied by private well: Yes ✓ No Is well proper: Yes i/ 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 J/ 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. TOILET/BATH FACILITIES: <br /> Number and locations existing: fz J Additional <br /> facilities needed: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> 7. GENERAL SANITATION: <br /> State any problems not previously noted: AA <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> EH 06 06 Rev IN9 <br />