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U <br /> k � <br /> i <br /> I <br /> 1. SEWAGE: " <br /> Distance to Public Sewers: ayi s 17V' — /)/-tk)bc� 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 /> 3 <br /> 2. WATER SUPPLY: 76 <br /> Is water supplied by private well: Yes No '� Is well proper: Yes No <br /> State deficiency: <br /> i <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 VECTOR POTENTIAL: <br /> State possible vector potential and necessary control: lVdI lc <br /> nz: <br /> 5. TOILETIBATH FACILITIES: <br /> 4 <br /> Number and locations existing ty t vi Additional <br /> facilities needed: ivvh <br /> t <br /> 6. PREVIOUS OPERATION HISTORY: <br /> 7. GENERAL SANITATION: <br /> State any problems not previously noted: GUS/ t <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: �",26 Q <br /> r <br /> f <br />