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I. SEWAGE: <br /> Distance to Public Sewers: Connection necessary: Yes No <br /> Does existing septic system comply with San Joaquin County Development Title 1549 <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 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: 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 VECTOP` <br /> State possible vector potential and o v N <br /> alloo +'i <br /> o N O O N <br /> C ul •- r. C <br /> n O O N N <br /> 5. TOILET/BATH FACILITIES: U <br /> Number and locations existing: — A Additional <br /> facilities needed: w <br /> 6. PREVIOUS OPERATION HISTw <br /> _ o <br /> Z G <br /> ., X Q " <br /> Q U 3 <br /> 7. GENERAL SANITATION: <br /> aaa�, <br /> State any problems not previously ;, N o <br /> R. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br />