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1. SEWAGE: <br /> Distance to Public Sewers: Connection necessary: Yes No <br /> Does existing septic system comply with San J'oa u' County Development Title 4549 ? <br /> Yes No Unknown If no, e <br /> Describe septic installation to be install <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? Y -No Is.the permit current? Yes No <br /> Does existing or proposed use m is well Public Water: Yes No Is water/well <br /> sampling current: yes o Additional information or comments: <br /> 3. GARBAGE & REFUSE: <br /> Licensed scavenger pick-up: Yes No Service Area No.: Other proposed <br /> disposal method: ,f __ ----- - ------_ - - <br /> Potential problem(s): <br /> 4. FLY, MOSQUITO OR VECTOR POTENTIAL: <br /> State possible vector potential and necessary co rok— <br /> 5. TOILETBATH FACILITIES: <br /> Number and locations existing: �' Additional <br /> facilities needed: <br /> 6. PREVIOUS OPERATION HISTOR <br /> iA4 11 1 S <br /> r <br /> D <br /> f <br /> 7. GENERAL SANITATION: <br /> State any problems not previously noted: <br /> S. POPULATION DENSITY: <br /> Approximate number of people per square <br /> �: <br />