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r <br /> 1. SENVAGE: " <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 /> iF <br /> Z. WATER SUPPLY: <br /> Is water supplied by private well: Yes No Is well proper: Yes G-- No <br /> State deficiency: <br /> Is well system a Public Water system? Yes -� � o Is the permit current? s No <br /> Does existing or proposed use make this well Public Water: Yes No Is water/well <br /> sampling current: yes No Additional information or comments: :Z:V 0-f <br /> CA <br /> 3. GARBAGE & REFUSE: <br /> � <br />.. Licensed scavenger pick-up: Yes ` o "<e� rv, ice Area No.: Other proposed` <br /> disposal method: <br /> Potential problem(s): <br /> 4. FLY MOS <br /> -QUITO OR VECTOR POTENTIAL: <br /> State possible vector potential and necess control: <br /> 5. TOILET/BATH FACILITIES: <br /> Number.-and locations existing: _ —^^"" Additional <br /> facilities needed: - <br /> 6. PREVIOUS OPERATIO HISTORY: <br /> 4r If <br /> 7. GENERAL SANITATION: <br /> State any problems not previously noted: <br /> 8. POPULATION DENSITY: <br /> Approximate number of people er square mi-1 <br /> 4 <br /> S <br /> i <br /> i <br />