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1 1. SEWAGE: <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 /> Z WATER SUPPLY: L/ `7 )00, <br /> ¢ ' _ �"" �!� <br /> Is water supplied by private well: Yes No Is well proper: Yes /--- No <br /> Sta d y: y <br /> ze <br /> / flu <br /> I 7 -r.."Oon ie pig , <br /> ell system a Public Water sy em. Yes No_,�Is t ermit cu <br /> Does existing or proposed use make this well Public Water: Yes No '�Is water/well rM f <br /> sam ling current: yes No Additional information or commVnts'::y -7 ! f, z y / <br /> r R rQd <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: �'^ Additional <br /> facilities needed: <br /> 6. PREVIOUS DPERATION HISTORY- <br /> 7. <br /> IST RY-7. GENERAL SANITATION: <br /> State any problems not previously noted: <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> Ak 4e e, J,5 A&AZ& <br /> j z' -t- e r--t��_ A- .� per v 1/ 13 45TA <br />