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� r <br /> 1. SEWAGE: 3r��'m S <br /> Distance to Public Sewers: A16W Connection necessary: Yes No <br /> Does existing septic system comply with San Joaquin County Development Title 9549 ? <br /> Yes ✓No - Unknown If no, exp ain:' <br /> AV /h FV 471 <br /> Describe septic installation to be installed: <br /> i <br /> 2. WATER SUPPLY: /V'"`e <br /> Is water supplied by private well: Yes No Is well proper: Yes No <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 Additional i formation or comments: <br /> 3. GARBAGE & REFUSE: <br /> Licensed scavenger pick-up: Yes r/ No Service Area No.: Other proposed <br /> disposal method: <br /> Potential problem(s): - <br /> 4. FLY, MOSQUITO.OR VECTOR_ POTENTIAL: <br /> - <br /> State possible vector potential and necessary control: 41 <br /> 5. TOILET/BATH FACILITIES: <br /> Number and locations existing: Additional <br /> facilities needed: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> 7. GENERAL SANITATION: <br /> State any problems not previously noted: D}7-6, <br /> S. POPULATION DENSITY: <br /> Approximate number of people per square mile: /41 <br />