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1 <br /> eA- <br /> 1. SEWAGE: <br /> Distance to Public Sewers: Connection necessary: Yes No <br /> Does existing septic system comply with San Joaquin County Development Title <br /> Yes No Unknown If no, explain: _ <br /> Describe septic installation to be installed: <br /> 7` <br /> i <br /> 2. WATER SUPPLY J,1 *1 s �`' �" G•J�" W ? TO u �' <br /> Is water supplied by private well: YesNo Is well proper: Yes_ze____ o �y <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 1/ Is water/well <br /> sampling current: yes No Additional informatio o comments: <br /> 3. GARBAGE & REFUSE: <br /> Licensed scavenger pick-up: Yes No Service _4rea No.: Other proposed <br /> disposal method: i�- <br /> Potential problem(s): <br /> 4. FLY, MOSQUITO OR VECTOR POTENTIAL: <br /> State possible vector potential and necessary control: <br /> S. TOILETBATH FACILI-TIES: <br /> Number and tocatiafis existing: �� A�- <br /> faoibAiaa-tweded: <br /> b. PREVIOUS OPERATION ISTORY• <br /> GENERAL SANITATION: <br /> State any problems not previously noted: <br /> S. POPULATION DENSITY: - <br /> Approximate number of people per square mile: <br />