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1. SEWAGE: � <br /> Distance to Public Sewers:ff� 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 /> De r"be septic install3tioaqto be inst led: _ <br /> t / / t <br /> 2. WATER SUPPLY: '� -72� -� <br /> Is water supplied by private well: Yes No swell proper: Yes No <br /> State deficiency: <br /> Is well system a Public Water system? Yes No ✓ 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 /> , <br /> 3. GARBAGE & X�f <br /> ck-up: Yes_, No ;Service Area No.: Other proposed <br /> Licensed scave��rPi <br /> disposal meth " <br /> Potential pro lem(s): <br /> 4. FLY MOSQUITO OR VECTOR POTENTIAL: <br /> State possible vector potential and necessary control: <br /> 5. TOILET/BATH/FACILITIES: 7X <br /> Number and 1 tions existing: JA tfitional <br /> facilities nee <br /> 6. • PREVIOUS OPERATION HISTORY: /� <br /> se <br /> Alo <br /> 7. GENERAL SANITATION: ��. _ <br /> State any problems not previously noted: <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> R <br />