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1. SE_WA GE• : Yes No <br /> Distance to Public Sewers: Connection necessary <br /> with San Joaquin County Development . Title #549 ? <br /> Does existing septic system comply <br /> Yes No Unknown If no, explain: <br /> Des e insta <br /> 2• WATER SUPPLY: well ll proper: Yes No <br /> Is water supplied by private well: Yes No <br /> State deficiency: <br /> Is well system.a Public Water system? Yes No Is the permit current? Yes—No— <br /> Does <br /> esNoDoes existing or proposed use make this well Public Water: Yes No <br /> Is water/well <br /> Additional information or comments: <br /> sampling current: yes No 7` <br /> 4 <br /> 3° GARBAGE & REFUSE: Other proposed <br /> Licensed scavenger pick-up: Yes No Service Area No.: p p <br /> disposal method: <br /> Potential problem(s): <br /> 4. FLY MOS UITO OR VECTOR POTENTIAL: <br /> State possible vector potential and necessary control. <br /> S. TOILET/BATH FACILITIES: Additional <br /> Number and locations existing: <br /> facilities needed: <br /> (. PREVIOUS OPERAT ON HISTORY: — �� <br /> ,s !/ �I. / <br /> 7. <br /> GENERAL SANITATION: <br /> State any problems not previously noted- <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> -r <br />