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1. SEWAGE: <br /> Distance to Public Sewers: _AiConnection necessary: Yes No <br /> Does existing septic system omply with San Joaquin County Development Title #549 ? <br /> Yes_1� No Unknown Ifno, explain: ✓ �/ <br /> Describe septic installation to be installed: <br /> 2. WATER SUPPLY: <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__1_zIs the permit current?Yes—No— <br /> Does <br /> esNoDoes existing or proposed use make this well Public Water: Yes No Is water/well <br /> 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: <br /> 5. TOILET/BATH FACILITIES: <br /> Number and locations existing: 'j. -e f�r- � Z, y Additional <br /> facilities needed: Ala" <br /> 6. PREVIOUS OPERATION HISTORY: s, <br /> 7. GENERAL SANITATION: <br /> State any problems not previously noted: ✓ � <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> EH 06 06 Rev 1199 <br />