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X12-2`12. U40 535 <br /> �S-3G(0 5355 <br /> 1. SELVAGE: I <br /> Distance to Public Sewers: —�" 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 /> 1"7--1 (Oo <br /> 2. - WATER SUPPLY: n� <br /> Is water supplied by private well: Yes No Is well proper: Yes �`' No <br /> State deficiency: <br /> 1 <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 X Is water/well <br /> sampling current: yes No Additional information or comm nts: a(� IS_CC <br /> �c 1 yA N_C� bf'b8a VV( 0VM 44� iso_ <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: <br /> 5. TOILET/BATH FACILITIES: <br /> Number and locations existing: i Additional <br /> facilities needed: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> V l V r r a rc64 btA <br /> 7. GENERAL SANITATION: <br /> State any problems not previously noted: <br /> {I <br /> S. POPULATION DENSITY: s <br /> Approximate number of people per square mile: <br /> lrptrl,Vlp� `PSG 1�'1 Y1� l5wv�.d ��b�� .� <br /> z <br />