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1. SEWAGE: <br /> Distance to Public Seg 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 /> 2. WATER SUPPLY: <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 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, M-0S0M'T-9-Q&MECT.0R POTENTIAL- <br /> State possible vector potential and necessary control: ( � ✓E� •` <br /> D S— PS' <br /> 5. TOILETBATH FACILITIES: <br /> Number and locations existing: <br /> fac�litiPc neP�led: T -�' � <br /> --\ „ 2 <br /> 6. PREVIOUS OPEI0 HISTORY: X �.00, �'F►f, <br /> 7. GENERAL SANITATION: <br /> State any problems not previously noted: <br /> CC <br /> 8. POPULATION DENSITY: �/P R EY r I LM <br /> Approximate number of people pe <br /> lackey W011$ <br /> Presiden�_ <br /> Wardley Industrial Inc. <br /> 2059 Williams Street•San Leandro,CA 94577 USA <br /> Ph.:51 o-483-8171 •Fax:510-483-8174 <br /> E-mail:wardleyfilm@msn.com <br />