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1. SEWAGE: <br /> Distance to Public Sewers: IV Connection necessary: Yes No <br /> Does existing septic system comply with San Joaquin County Developtpent Ile #549 ? <br /> Yes No Unknown Ifno, ex 1�ip: _4 rt Sr =144 <br /> L' r, tc to, cU—,"AAnt INLNfw� Seenc Jyjd / O <br /> Describe septic installation to be installed: <br /> U — 1— 4/0 3 6"pl I i PS S <br /> is <br /> eVA104, <br /> 2. WATER SUPPLY: <br /> Is water supplied byWal?well: Yes No I wfj1�1 prop r: Yes No <br /> State deficiency: !( OJua � �C k �i <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: <br /> Licensed scavenger pick-up: Yes No Service Area No.: Other proposed <br /> disposal method: <br /> Potential problem(s): � l D Q <br /> 4. FLY, MOSQUITO OR VECTOR POTENTIAL: / <br /> St a possib vector potential and n cessary on of <br /> 14N �l01 nU �ANk G � r nM� <br /> 5. TOILETBATH FACILITIES: <br /> Number and locations existing: MAO Au Q p,d�/ Additional <br /> facilities needed: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> 7. GENERAL SANITATION: <br /> State any problems not previously noted: tD <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br />