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1. SEWAGE: <br /> Distance to Public Sewers: Connection necessary: Yes No ---_ <br /> Does existing septic system comply with San Joaquin County Development. Title #549 ? <br /> Yes No Unknown If no, explain: <br /> Descp�!sttla > stalled: <br /> r 5 <br /> v <br /> 2. WATER UPPL <br /> Is water supplied by privat well: Yes No Is well proper: Yes No <br /> State deficiency: <br /> Is well system a Public Water system? Yes No _ s the permit ? Yes No <br /> Does existing or proposed use make this well Public Water: Yes Nocurre Is water/well <br /> sampling current: yes No Additional information or comments: <br /> 3. GARBAGE & REFUSE: <br /> Licensed scavenger pick-up: Yes No Service Area No.: Other proposed <br /> disposal method: <br /> Potential problern(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: _ Additional <br /> facilities needed: <br /> G. PREVIOUS OPERATION HISTORY: <br /> G <br /> 7. GENERAL SANITATION: <br /> State any problems not previously noted: <br /> 8. POPULATION DENSITY: _ <br /> Approximate number of people per square mile: <br />