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1, SEWAGE: <br /> Distance to Public Sewers: Connection necessary: Yes No <br /> th San Joaquin County Development Title 4549 ? <br /> Does existing septic system comply <br /> Yes No Unknown if no, explain: <br /> Describe septic installation to be installed: <br /> 2. WATER SUPPLY: Ill proper: Yes No <br /> S we <br /> Is water supplied by private well: Yes No <br /> State deficiency: <br /> is well system a Public Water system? Yes No Is the permit current? Yes-No- <br /> Does <br /> esNoDoes 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- <br /> disposal <br /> Other proposed <br /> o Service Area No.: <br /> disposal method: <br /> Potential problem(s): <br /> I. FLY VIOS UITO OR VECTOR POTE�iTIAL: <br /> State possible vector potential and necessary control: <br /> TOILET/BATH FACILITIES: 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 /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br />