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w <br /> 1. SEWAGE: k�, <br /> Distance to Public Sewers: oA S\V 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: No <br /> Is water supplied by private well: Yes No Is well proper: Yes <br /> State deficiency: <br /> t? Yes No <br /> Is well system a Public Water system? Yes Na Is the permit Curren <br /> Does existing or proposed use make this well Public Water: Yes No Is water/well <br /> i 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: r� ' <br /> i <br /> t <br /> 5. TOILETBATH FACILITIES: <br /> Number and locations existing: Additional <br /> facilities needed: <br /> b. PREVIOUS OPERATION HISTORY: <br /> �c,Qrl 1 <br /> 7. GENERAL SANITATION: <br /> State any problems not previously noted: <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br />