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X <br /> 1. SEWAGE: <br /> Distance to Public Sewers: --�" ^ Connection necessary: Yes No <br /> Does existing septic system comply with' San 3oa pin County Development Title #549 ? <br /> Yes No Unknown If no, ex <br /> Describe septic installation to be installed: <br /> 2. WATER SUPPLY: <br /> Is water supplied by private well: Yes Io`: No Is well proper: Yes o <br /> State deficiency:,. - - - ` <br /> Is.well system a Public Water system? Yes No Is the permit current? Yes No <br /> t 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 /> - s <br /> 3. GARBAGE & REFUSE: <br /> Licensed scavenger pick-up: Yes No Service Area No.;_ Other proposed F <br /> I <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: Additional <br /> facilities needed: <br /> 6. PREVIOUS OPERATION HISTORY: ', 1 <br /> 7. GENERAL SANITATION: <br /> State any problems not previously noted- <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square�rnile: <br /> d <br />