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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 installatio to be install : <br /> 2. WATER SUPPLY: <br /> Is water supplied by private well: Yes No [s well pro r: Yes o <br /> State defici cy: <br /> s well system a Public Wat ystem? Yes No_,K_Is the permit current? Yes No <br /> Does existing or proposed use make this well Public Water: Yes Nom Is water/well <br /> sampling current: yes Noir Additional information or comments: <br /> 3. GARBAGE & REFUSE: <br /> Licensed scavenger pick-up: Yes No Se vice urea No.: Other proposed <br /> disposal method: <br /> Potential problem <br /> 4. FLY, MOSQUITO OR VECTOR POTENTIAL: <br /> State possible vector potential and necessary control: <br /> 5. TOILET/BATH FACILITIES: <br /> Number and locations existing: ,01y;" _ Additional <br /> facilities needed: <br /> 6. PREVIOUS OPERATION HISTORY: / <br /> 7. GENERAL SANITATION: <br /> State any problems not previously noted: tel/ <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: I� <br />