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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: <br /> Is water supplied by private well: Yes zNo 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 existing or proposed use make this well Public Water: Yes No <br /> is waterlwell <br /> sampling current: yes No Additional information or comments: <br /> 3. GARBAGE & REFUSE: / <br /> Licensed scavenger pick-up: Yesy 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: ,l.L�h 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 /> g. POPULATION DENSITY: <br /> Approximate number of people per square mile: '�-*J <br />