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o � <br /> 1 . SEN'AGE: <br /> Distance to Public Sewers: Connection necessary: Yes No <br /> Does existing septic system complx with San Joaquin County Development Title #549 ? <br /> Yes No Unknown If no. explain: <br /> Describe septic installation to be installed: <br /> 2. NATER SLTPPLY: <br /> Is water supplied by private well: YesNo 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 /> 4L L:rr_!1/_r' <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. <br /> roblem(s):4. FLY, MOSQUITO OR VECTOR POTENTIAL: <br /> State possible vector potential and,necessary control: <br /> �. TOILETBATH FACILITIES: <br /> Number and locations existing: Additional <br /> facilities needed: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> ,1 <br /> 7. GENERAL SANITATION: <br /> State any problems not previously noted: <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square <br />