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1. SEWAGE: <br /> Distance to Public Sewers: Connection necessary: Yes No L <br /> Does existing septic system comply with San Joaquin County Development Title #549 ? <br /> Yes No Unknown L If no, explain: <br /> D-6- e- septic nstallation to be ins lied: <br /> 2. WATER SUPPLY: <br /> Is water supplied by private well: YesNNo well proper: Yes No <br /> State deficiency: Y � <br /> / e ► T! 4. <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 <br /> 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. TOILET/BATH 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 /> S. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br />