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y i <br /> e <br /> 1. SEWAGE: /J6 P"4n c 1r1� <br /> Distance to Public Sewers: t�Xt-em r)& Connection necessary: Yes No X 4 <br /> Does existing septic system comply with San Joaquin County Development Title 4549 ? <br /> Yes No Unknown If no, explain: <br /> Describe septic installation to be installed: <br /> 2. WATER SUPPLY:7& I C— - <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 0,1 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, iIMOSOUITO OR VECTOR POTENTIAL: <br /> State possible vector potential and necessary control: Xl D ' <br /> 5. TOILETBATH FACILITIES: <br /> Number and locations cxi" sting: ,GI Z�fu s Additional <br /> facilities needed: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> S <br /> r h 'l!4`�Uk <br /> 7. GENERAL SANITATION: <br /> State any problems not previously noted: d <br /> S <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: ��ic�0�� <br />