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Z" <br /> 1. SEWAGE: <br /> Distance to Public Sewers: NES - <br /> Connection necessary: Yes No <br /> Does existing septic system comply with San Joaquin County Development . Title #549 ? <br /> Yes No Unknown If no, explain: <br /> Describe septic installation to be installed: <br /> t <br /> 2. WATER SUPPLY: <br /> Is water supplied by private well: Yes No Is well proper: Yes No <br /> State deficiency: cm <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 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: a svKm%as " <br /> Potential problem(s): <br /> 4. FLY, MOSQUITO OR VECTOR POTENTIAL: <br /> State possible vector potential and necessary control: <br /> 5. TOILETIBATH FACILITIES: <br /> Number and locations existing: po"& Additional <br /> facilities needed: -eV_. pew r tiL6�� <br /> b. PREVIOUS OPERATION HISTORY: <br /> RO N C H �Ine-V u-.vw ►9 f�N l�t rte <br /> t <br /> 7. GENERAL SANITATION: c `p <br /> State any problems not previously noted: <br /> 8. POPULATION DENSITY: ram f ry gk <br /> Approximate number of people per square mile: 13 C I vcr I/sG 1+ 1J�"US -1'$*P&*A-- <br />