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1. SEWAGE; <br /> Distance to Public Sewers: Connection necessary: Yes No <br /> Does exis Ing 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: <br /> Is water supplied by private well: Yes �� No Is well proper: Yes No !� <br /> State deficiency: <br /> �/y>iTA/2i.r �X �, ..t1,✓/,P /C+���'7�-�2�J4+I�is/ �� /�Y� _ __ <br /> Is well system a Ptrli is 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 MOS UITO OR VECTOR POTENTIAL: <br /> State possible vector potential and necessary control: <br /> 5. TOILETBATH FACILITIES: <br /> Number and locations existing: Additional <br /> facilities needed: <br /> i <br /> 6. PREVIOUS OPERATION HISTORY: <br /> �i/L��ifs+/�r• --�t.�►� _�../1 �,o� <br /> 7. GENERAL SANITATION: <br /> State any problems not previously noted: o <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: r� G <br /> C/ <br />