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r <br /> A <br /> 1. SEWAGE: <br /> Distance to Public Sewers: Connection necessary: Yes No <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: / <br /> Is water supplied by private well: Yes V No Is well proper: Yes No 4/ <br /> State deficiency: IJE�-t_ roN N6Lr book - NEE i7 Tfi5Roof,' r Ne:0 !< tx - + <br /> Is well system a Public Water system? Yes No LAs 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 /> I <br /> 3. GARBAGE & REFUSE: <br /> Licensed scavenger pick-up: Yes No Service Area No.: Other proposed x <br /> disposal method: <br /> Potential problem(s): . <br /> 4. FLY MOSQUITO OR VECTOR POTENTIAL: <br /> State possible vector potential and necessary control: <br /> 5. TOILETBATH FACILITIES: <br /> Number and locations existing: _ )VU a oto 5¢ Additional <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: 0006& s rvlr R�R � C''T + <br />