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s <br /> A <br /> 1. SEWAGE Connection necessary: Yes- No <br /> Distanceto Public Sewers: <br /> Does existing septic system c mply with San Joaquin County Development . Title #549 . <br /> Do If no, explain: <br /> Yes�' No_ Unkno <br /> Describe septic installation to be installed: <br /> 2. WATER SUPPLY: Z. No Is well proper: Yes <br /> ✓ No <br /> Is water supplied by private well: Yes <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- <br /> Additional information or comments: <br /> 3, GARBAGE & REFUSE: Service Area No.'-Other proposed <br /> I14 Licensed scavenger pick-up: Yes No_ <br /> disposal method: <br /> Potential problem(s): <br /> 4. FLY MOS UITO OR VECTOR POTENTIAL- <br /> State <br /> OTE N IA- <br /> State possible vector potential a necessary <br /> 5. TO <br /> ILETIBATH FACILITIES: Additional <br /> Number and locations existing: <br /> facilities needed: <br /> i <br /> t <br /> b. PREVIOUS OPERATION HISTORY: <br /> 7. GENERAL SANITATION: <br /> y State any problems not previously noted: . <br /> g, POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> r <br />