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1. SEWAGE: 6f�IrY1 'I <br /> Distance to Public Sewers: Connection necessary: Yes No <br /> ` Does existing septic system comply with San Joaquin County Development Title 949 ? <br /> Yes No- Unknown If no. explain: <br /> { Describe septic installation to be installed: <br /> 2. WATER SUPPLY: <br /> OUD �Er rn, s � <br /> M Is water supplied by private well: Yes No Is well proper: Yes No <br />[l 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 information or comments: <br /> 3 <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: 1111114- <br /> 5. <br /> U1«5. TOILET/BATH FACILITIES: /�- <br /> Number and locations existing: XCs�d/ /�l �7 27n Additional <br /> facilities needed: <br /> 5. PREVIOUS OPERATION HISTORY: <br /> 7. GENERAL SANITATION: <br /> State any problems not previously noted: <br /> 8. <br /> POPULATION DENSITY: <br /> Approximate number of people per square mile: �u✓hi� <br />