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AW- <br /> 1. SEWAGE: <br /> Distance to Public Sewers: A/ 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 /> 2. WATER SUPPLY: <br /> Is water supplied by private well: YessNo Is well proper: Yes No <br /> State deficiency:2j Vu•eV5 d:w 5ko 6, CLba'-'_kms WZA — fl n t --W V�_ <br /> 1�14ai- O( 1 F'fI.JWA - KUk {v So.e 61,En' .e ILL i' �e r�eµ.t� <br /> Is we�lem 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. 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. TOILETBATH FACILITIES: <br /> Number and locations existing: A <br /> facilities needed: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> 7. GENERAL SANITATION: <br /> State any problems not previously noted: <br /> POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> i <br />