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1. SEWAGE: V/� <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 f no, explain: <br /> Describe septic installation to be installed: <br /> 2. WATER SUPPLY: <br /> Is water supplied by private w ll: Yq� No I well proper: Yes No <br /> State deficiency: Tt <br /> d0 q S F}t <br /> Is well system ayublic Water system? Yes r Is the permit current? Yes No <br /> Does existing or proposed use make this well Public Water: Yes NoIs 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: /yl <br /> State possible vector potential and necessary control: / <br /> 5. TOILETBATH FACILITIES: <br /> Number and locations existing: Additional <br /> facilities needed: <br /> 6. PREVIOU OP RATI N HISTORY: <br /> � � Avi <br /> 7. GENERAL SANITATION: Q O <br /> State/ y pr Mems previously noted: <br /> 8. POPULATION D NSITY: <br /> Approximate number of people per square mile: 4/21d <br />