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z <br /> Art ' <br /> 1. SEWAGE: A/M- Connection necessary: Yes No <br /> Distance to Public Sewers: <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: well proper: Yes No <br /> Is water supplied by private well: Yes No ✓ Is P p <br /> State deficiency: <br /> Is well system a Public Water system? Yes Na Is the permit current?I water/well <br /> No- <br /> Does existing or proposed use make this well Public Water: Yes No <br /> sampling current: yes No Additional information or comments: <br /> 3. GARBAGE & REFUSE: Other proposed <br /> Licensed scavenger pick-up: Yes No <br /> Service Area No.: <br /> disposal method: <br /> Potential problem(s): <br /> 4. FLY MOS UITO OR VECTOR POTENTIAL: <br /> E State possible vector potential and necessary control: !� <br /> 5. TOILETBATH FACILITIES: Additional <br /> Number and locations existing: G �� ! <br /> .Z� <br /> facilities needed: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> 7. GENERAL SANITATION: <br /> State any problems not previously noted: <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square in <br />