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1. SEWAGE: <br /> Distance to Public Sewers: Connection necessary: Yes No <br /> Does existing septic syste comply with San Joaquin County Development Title 4549 ? <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: Yes _ No Is well proper: Yes /r No <br /> State deficiency: �WL <br /> Is.well system a Public Water system? Yes No Is the permit curry nt? Yes No <br /> Does existing or proposed use make this well Public Water: Yes Nov Is water/well <br /> sampling current: yes No Additional information or comments: <br /> IC g R r Tc A - <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: 3 � � �Oc�� 5 �� Noas6 Additional <br /> Number and locations existing- <br /> facilities needed: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> OXI Lo Vtt o R`zr wG- <br /> 7. GENERAL SANITATION: <br /> State any problems not previously noted: A,)U <br /> S. POPULATION DENSITY: Ru R-*i- <br /> Approximate number of people per square mle <br /> ile: <br /> } s <br />