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1. SEWAGE: ?�� Connection necessary: Yes No <br /> `• <br /> Distance to Public Sewers: kty " %1 <br /> Does existin ' septic system comply `wfT;%an 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 Is well proper: Yes No <br /> State deficiency: <br /> Fs well system a Public Water system? Yes Nor'" Is the permit current? Yes—No— <br /> Does <br /> esNoDoes 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: .. <br /> 5. TOILETBATH FACILITIES: Additional <br /> Number and locations existing: <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 /> i <br /> ' CH 06 06 Rev 1199 <br />