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1 <br /> 1. SEWAGE: <br /> Distance to Public Sewers: /U m`�— Connection necessary: Yes No <br /> system comply with San Joaquin County Development Title 4549 <br /> Does existing septic ? <br /> Yes No Unknown �c 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 /> Is water/well <br /> Does existing or proposed use make this well Public Water: Yes No <br /> sampling current: yes No Additional information or comments: <br /> I <br /> 3. GARBAGE & REFUSE: Otherproposed <br /> Licensed scavenger pick-up: Yes �No Service Area Na.: - <br /> disposal method: <br /> Potential problem(s): <br /> a <br /> 4. FLY MOS UITO OR VECTOR POTENTIAL: <br /> State possible vector potential and necessary control: Xff 176-71eY <br /> 5. TOILETBATH FACILITIES: rs�� ��� Additional <br /> Number and locations existing: /� <br /> facilities needed: 40 l.Uzz� s <br /> 6. PREVIOUS OPERATION HISTORY: <br /> 6 i G1i� <br /> 7. GENERAL SANITATION: <br /> State any problems not previously noted: <br /> 8. POPULATION DENSITY: / <br /> Approximate number of people per square mile: r�c/� <br />