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5 <br /> 1. SEWAGE: <br /> Distance to Public Sewers: ����t�� Connection necessary: Yes `"__­ Ni <br /> Does existing septic system comply with San Joaquin County Developtnent Title #549 `? <br /> Yes No UnknowA 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: Yeses No <br /> State deficiencv: <br /> Is well system a Public Water system'? Yes Nom 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_­­". <br /> o--" Additional information or comments: <br /> 3. GARBAGE & REFUSE: _ <br /> Licensed scavenger pick-up: Yes `"r No Service Area No.: Other proposed <br /> disposal method: <br /> Potential problem(s): <br /> 4. FLY MOSQUITO OR VECTOR POTENTIAL: <br /> State possible vector potential and necessary control: _e��,z� c'.. „c� __... <br /> 5. TOILET/13ATH FACILITIES: <br /> Number and locations existing: Additional <br /> facilities needed: <br /> 6. PREVIOUS OPERATION HISTORY: -- <br /> 7. GENERAL SANITATION: <br /> State any problems not previously noted: <br /> S. POPULATION DENSITY: <br /> Approximate number of people per square mile. c7 <br /> la 106 06 Rev 1199 <br />