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S ®_ /67Yb <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 /> Describe septic installation to be installed: <br /> 2. WATER SUPPLY: i/ <br /> Is water supplied by private well: Yes No Is well proper: Yes V No <br /> State deficiency: <br /> Is well system a Public Water system? Yesio s e pe it current? Yes ✓No <br /> Does existing or proposed use make this well Public Water: Yes c7No Is water/well <br /> sampling current: yeses No Additional informati r commFnts: <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 MOSOUITO 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. PREVIO S OPE TION HISTORY: <br /> J D� <br /> 7. GENERAL SANITATION: `- <br /> State any problems not previously noted: <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br />