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i <br /> I <br /> 1. SEWAGE: <br /> Distance to Public Sewers: Connection necessary: Yes No <br /> Does existing septic system comply with San Joaquin County Development . Title 4549 ? <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_ 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 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: v <br /> No P Service Area No.: Other proposed <br /> Licensed scavenger pick-up: Yes <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: Additional <br /> Number and locations existing: 1W e <br /> facilities needed: <br /> 6, PREVIOUS OPERATION HISTORY: <br /> I <br /> I <br /> 7. GENERAL SANITATION: <br /> F State any problems not previously noted: L OiV E <br /> 8. POPULATION DENSITY: Ru � <br /> Approximate number of people per square mile: <br /> i <br /> i <br /> r <br />