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1. SEW <br /> Distance to Public Sewers: <br /> Does existing septic system comply with San Joaquin County necessary:Developsment No_ <br /> Yes No Unknown Title #549 <br /> If no, explain: <br /> Describe septic installation to be installed: <br /> 2• WATER SUPPLY: <br /> Is water supplied by private well: Yes <br /> State deficiency: No- Is well proper: Yes No <br /> Is well system a Public Water system? Yes <br /> Does existing or proposed use make this well Public Water: Yes No <br /> permit current? Yes No No <br /> sampling current: yes No Is water/well <br /> Additional information or comments: <br /> 3. GARBAGE & REFUSE: <br /> Licensed scavenger pick-up: Yes No <br /> Service Area No.: <br /> disposal method: Other proposed <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: _ <br /> facilities needed: Additional <br /> 6• PREVIOUS OPERATION HISTORY: <br /> 7• GENERAL SANITATION: <br /> State any problems not previously noted: <br /> 8. POPULATION DENSITY: <br /> Approximate number of people; per square mile: <br />