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1. SEWAGE: <br /> Distance to Public Sewers: Connection necessar,T: Yes No <br /> Does existing septic system comply with San Joaquin County Development Title 9549 <br /> Yes No Unknown If no; explain: <br /> Describe septic installation to be installed: <br /> �I <br /> �I <br /> �l. <br /> 2. WATER SUPPLY: <br /> Is water supplied by private well: Yes � No Is well proper: Yes VINO <br /> State deficiency: 1- <br /> 11 <br /> Is well system a Public Water system? Yes 11 No Is the permit current? Yes No <br /> Does existing or proposed use make this well Public Water: Yes No Is water/well <br /> sapling current: yes N Additional information or comments: <br /> J �I <br /> 3. GARBAGE & REFUSE: <br /> _. Licensed scavenger pick-up: Yes No Service Area No.: Other proposed <br /> disposal method: IL <br /> Potential problem(s): �I <br /> 4. FLY MOSQUITO OR VECTOR POTENTIAL: <br /> State possible vector potential and necessary control: <br /> �I <br /> 5. TOILETBATH FACILITIES: <br /> Number and locations existing. Additional <br /> facilities needed: �I <br /> 6. PREVIOUS OPERATION HISTORY: <br /> f <br /> �I <br /> 7. GENERAL SANITATION: I <br /> State any problems not previously noted: L <br /> �I <br /> S. POPULATION DENSITY: <br /> Approximate: number of people per square mile: <br /> I <br /> t <br />