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1. SEWAGE: <br /> Distance to Public Sewers: " Connection necessary: Yes N .•'' �/ <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: <br /> Is water supplied by private well: Yes 1,/`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 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 T VECTOR POTENTIAL: <br /> State possible vector pQtenti,ul-andrzec' spycontrol:N , <br /> 5. TOILET/BATH FACILITIES: I <br /> Number and locations existing: Additional <br /> facilities needed: <br /> 6. PREV US OPE TIO HISTORY: <br /> 7. GENERAL SANITATION: <br /> Staw-anyjxT Mems eviously <br /> 8. POPULATION- NSITY: <br /> Approximate numb of pc e mile: Y <br /> ,_ <br />