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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 i e installed: <br /> .y 4 , C _ 7Pyri <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 snake this well Public Water: Yes No Is water/well <br /> sampling curr t: yes NoAdditional info_. atio or c ments: <br /> 3. GARBAGE & REFUSE: V/ —C � <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: <br /> o / d T <br /> AA <br /> C' l c� /�Com' •" C I �"1 I �% ` 41-e t <br /> 5. TOILETLBATH FAC4LITIES: e SC-c. t� y � � qQ Well <br /> NA* rrberatr[d"tocations existing: a �l <br /> facilities needed: <br /> 6. PREVIOUS OPERATION HISTORY <br /> 7. GENERAL SANITATION: <br /> State any problems not previously noted: <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> rr R ` <br /> v e 7' r r foe- <br /> 7/ <br /> O✓ <br /> 7, 07,1 <br />