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1 _ SEM AGE: <br /> Distance to Public Sewers: Connection necessary: Yes No <br /> Does existing septic system compl-, with San Joaquin Countv Development Title #549 <br /> Yes No Unknown If no. explain: <br /> Descptic i stallation to b d: IN, , <br /> c <br /> 2. WATER SUPPLY: �' <br /> Is water supplied by private well: Yes J No Is well proper: Yes � No <br /> State deficiency.- <br /> Is <br /> eficiency: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: yes No Additional information or comments: <br /> 3. GARBAGE & REFUSE: <br /> Licensed scavenger pick-up: Yes 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: <br /> 5. TOILETBATH FACILITIES: <br /> Number and locations existing: Additional <br /> facilities needed: <br /> 6. PREVIPUS OPERATIO T HISTORY: <br /> ` / _07 <br /> O • <br /> 7. GENERAL SANITATION: <br /> State any problems not previously noted: - <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br />