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7 <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 /> Descri-es=' d: S J <br /> I <br /> F <br /> 2. WATER SUPPLY: <br /> Is water supplied by private well: Yes I 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 /> Does existing or proposed use make this well Public Water: Yes No Is water/well <br /> sampling current: es No Additional information or comments: %S <br /> i ' <br /> 3. GARBAGE &t REFUSE: <br /> Licensed scavenger pick-up: Yes No Service Area No.: Other proposed <br /> disposal method: <br /> Potential problem <br /> u iy -7 ...Gl.�d�•� f <br /> 4. FLY, MOSQUITO OR VECTOR POTENTIAL: <br /> State possible vector potential and necessary control: <br /> 5. TOILET/BATH FACILITIES: <br /> Number and locations existing: Additional <br /> facilities needed: <br /> 6. PREVIOUS OPERATION HISTORY: / <br /> 7. GENERAL SANITATION: s / <br /> State any problems not previo sly oted: / <br /> 8. POPULATION DENSITY: Y <br /> Approximate number of people per square mile: <br />