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a. <br /> 1 4 <br /> L SEWAGE: Connection necessary: Yes No <br /> Distance to Public Sewers: <br /> with San 3oaquin County Development , Title <br /> Does existing septic system comply #54 <br /> Yes No Unknown If no, explain: <br /> Describe septic installation to be installed: <br /> 2. WATER SUPPLY: Is well proper: Yes No- <br /> is water supplied by private well: Yes No <br /> State deficiency: <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 aterlwell <br /> Is w <br /> sampling current: yes No Additional information or comments: <br /> 3. GARBAGE & REFUSE: <br /> I No Service Area No.:_Other proposed <br /> Licensed scavenger pick-up: Yes <br /> disposal method: <br /> Potential problem(s): <br /> 4, FLY MOS UITO OR VECTOR POTENTIAL: <br /> State possible vector potential and necessary control: <br /> S. TOILETIBATH FACILITIES: Additional <br /> Number and locations existing: <br /> ! facilities needed: <br /> 5 6. PREVIOUS OPERATION HISTORY: <br /> 7. GENERAL SANITATION: <br /> State any problems not previously noted: <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> i <br /> f <br />