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I <br />SEWAGE: <br />Distance to Public Sewers: Connection necessary: Yes <br />Does existing septic system comply with San Joaquin County Development <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 <br />State deficiency: <br />3. <br />4. <br />5. <br />6. <br />_ No <br />Title #549 ? <br />Is well proper: Yes No <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 />GARBAGE & REFUSE: <br />Licensed scavenger pick-up: Yes. <br />disposal method: <br />Potential problem(s): <br />No Service Area No.: Other proposed <br />FLY, MOSQUITO OR VECTOR POTENTIAL: <br />State possible vector potential and necessary control: <br />TOILETBATH FACILITIES: <br />Number and locations existing: <br />facilities needed: <br />PREVIOUS OPERATION HISTORY: <br />7. GENERAL SANITATION: <br />State any problems not previously noted: <br />8. POPULATION DENSITY: <br />Approximate number of people per square mile: <br />Additional <br />