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1. SEWAGE: <br /> Distance to Public Sewers: All-41 Connection necessary: Yes No J <br /> Does existing septic system comply with San Joaquin County Development Title #549 ? <br /> Yes No Unknown r f no, explain: <br /> Describe septic installation to be installed: <br /> 2. WATER SUPPLY: <br /> Is water supplied by private well: Yes t' No Is well proper: Yes Y No <br /> State deficiency: <br /> Is well system a Public Water system? Yes No x 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: YesNo 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: jjq (3u, t.pr^i6 5 Additional <br /> facilities needed: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> NURSeR �ND PAf� C'6�w���R� rc>ENC'E <br /> 7. GENERAL SANITATION: <br /> State any problems not previously noted: M)V6 <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: 6 D6eR66'1*NTl6}(. To R A*t , <br /> r <br />