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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 L;O�" If no, explain: <br /> De ation to <br /> 2. WATER SUPPLY <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? Yes4.-'No Is the permit current? Yes_j-- No <br /> Does existing or proposed use make this well Public Water: Yes No Is water/well <br /> samplin current: yes ��o Additional inform tion or comments: ,�Lt Zvi. <br /> ej iz,sr Q <br /> �' � � � �-MWC� [•JCt v el _ <br /> 3. GARBAGE & REFUSE: <br /> Licensed scavenger pick-up: Yeses o Service Area No.: Other proposed <br /> disposal method: <br /> Potential problem(s): <br /> 4. FLY, MOSQUITO OR VECTOR POTENT7dba ' <br /> State possible vector potential and ece s control: i `O�•t r <br /> pL� [� � , <br /> 5. TOILETBATH FACILITIES: <br /> Number and locations existing: Additional <br /> facilities needed: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> Z - r <br /> 7. GENE S M <br /> ION: n� U��"" rG �\ L5 � � <br /> State anleets ..��v <br /> previously noted: � ✓ <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> 1—C �G�•i� S o! <br />