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3. <br />SEWAGE: <br />Distance to Public Sewers:�U� Connection necessary: Yes <br />Does existing septic system comply with San Joaquin County Development <br />Yes No Unknown / If no, explain: <br />Describe septic installation to be installed: <br />WATER SUPPLY: <br />Is water supplied by private well <br />State deficiency: <br />_ No I— <br />Title #549 ? <br />Yes ✓ No Is well proper: Yes ✓ No <br />Is well system a Public Water system? Yes No—Is the permit current? Yes No <br />Does existing or proposed use make this well Public Water: Yes No v1Is water/well <br />sampling current: yes No Additional information or comments: <br />GARBAGE & REFUSE: <br />Licensed scavenger pick-up: <br />disposal method: <br />Potential problem(s): <br />Yes No ✓ Service Area No.: Other proposed <br />4. FLY MOSQUITO OR VECTOR POTENTIAL: <br />State possible vector potential and necessary control: <br />11 <br />6. <br />7. <br />EM <br />TOILETBATH FACILITIES: <br />Number and locations existing: /MGBjn�'/ Additional <br />facilities needed: <br />PREVIOUS OPERATION HISTORY: <br />GENERAL SANITATION: <br />State any problems not previously noted: <br />POPULATION DENSITY: <br />Approximate number of people per square mile: Lal 1260-4c R-t;"S <br />EH 06 06 Rev 1/99 <br />