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1. SEWAGE: <br /> Distance to Public Sewers: )✓�1' 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 X 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,MOSQUITO OR VECTOR POTENTIAL: <br /> State possible vector potential and necessary control: JA ()EW Ro6e 6 m 5 <br /> 5. TOILETBATH FACILITIES: <br /> Number and locations existing: o N E 'IV 14('911-1- Hf>M ' Additional <br /> facilities needed: wv-- FRPP45xP; ud j x4y'; <br /> 6. PREVIOUS OPERATION HISTORY: <br /> QN Y,'VJJWN Pfok 1;6u t*qe- j'ICF 0;--(' Ly <br /> 7. GENERAL SANITATION: <br /> State any problems not previously noted: Sorg%, �i-,f s ! 1kopi TIE S r 1 PQ,�6 M <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: �0 <br />