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A <br /> i. SE AGE: NVN <br /> Distance to Public Sewers: Connection necessary: Yes No <br /> Does existing septic system comply with San Joaquin County Development . Title #549 ? <br /> Yes <br /> No Unknown If no, explain: <br /> Describe septic installation to be installed: <br />�I <br /> 2. WATER SUPPLY: �"� Ae s y✓ <br /> Is water supplied by private well: Yes ✓ No Is well proper: 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 Is water/well <br /> sampling current. yes No Additional information or comments: <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 MOSQUITO OR VECTOR POTENTIAL: <br /> State"possible vector potential and necessary control: 'a 4hC <br /> 5. TOILET/BATH FACILITIES: Additional <br /> Number and locations existing: Ad h <br /> facilities needed: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> A,AJF <br /> .� a <br /> 7. GENERAL SANITATION: <br /> State any problems not previously noted. S <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> i <br />