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l <br /> L <br /> 1. SEWAGE: A i <br /> Distance to Public Sewers: A/'i Connection necessary: Yes No V/ <br /> Does existing septic system comply with San Joaquin County Development Title 9549 ? <br /> Yes No Unknown ✓ If no, explain: <br /> U'r. warn <br /> Describe septic installation to be installed: <br /> 2. WATER SUPPLY: <br /> I w v w /N' ow <br /> Is water supplied by pn ate ell: Yes 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, iMOSOUI_TO. OR VECTOR POTENTIAL: <br /> State possible vector potential and necessary control: <br /> 5. TOILETIBATH FACILITIES: <br /> Number and locations existing: Additional <br /> facilities needed: <br /> G. PREVIOUS OPERATION HIST RY: <br /> 7. GENERAL SANITATION: <br /> State any problems not previously noted: <br /> S. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> i <br />