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1. SEWAGE: Connection Yes No's <br /> Distance to Public Sewers: r --�- necessary: <br /> Does existing septic em comply with San Joaquin County Development Title #549 ? <br /> Yes No Unknown If no, explain: <br /> Describe septic installation to be installed: <br /> /� ry 40 '/ o y <br /> 2.� �VATEPt SUPPLY: � 00 � " - 7 7 <br /> Is water supplied by private well: Yes i�— No Is well proper: Yes j.�No <br /> State deficiency: <br /> Is well system a Public Water system? Yes No�Ts the permit current? Yes No V <br /> Does existing or proposed use make this well Public Water: Yes No Lam" Is water/well <br /> sampling current: yes No Additional information or comments: L/ <br /> 3. GARBAGE & REFUSE: <br /> Licensed scavenger pick-up: Yes �No Service Area No.: Other proposed <br /> disposal method: <br /> Potential problem(s): <br /> �C✓'a G `i <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: IAdditional <br /> facilities needed: <br /> 6. PREY OUS OPERATION HISTORY: <br /> �► tom/ Q✓ _ S / / <br /> 7. GENERAL SANITATION: <br /> State any problems not previously noted: <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br />