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Connection necessary: Yes No <br /> 1 DistancePublic Sewers: �� � <br /> Does existing septic system comply } th San n quin County Development Title #549 ? <br /> ✓ If no,explai <br /> Yes No Unknown <br /> Describe septic installation to be installed: <br /> 2, WATER SUPPLY: es `' No <br /> � <br /> Is water supplied by private well: Yes No Is well proper: Y <br /> State deficiency: <br /> Is the permit current?Yes No <br /> Is well system a Public Water system? Yes ° Is water/well <br /> Does existing or proposed use make this well Public Water: Yes No <br /> sampling c ent: yes No Additional i ormation or.comments: <br /> o ( S q <br /> 3. GARBAGE & REFUSE: Service Area No.: proposed <br /> Other <br /> Licensed scavenger pick-up: Yes No <br /> disposal method: <br /> Potential problem(s): <br /> 4, FLY MOS UITO OR VECTOR POTENTIAL: �—lk <br /> State possible vector potential and necessary control: <br /> 5, TOILETBATH FACILITIES: Additional <br /> Number and locations existing: <br /> facilities needed: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> 7, GENERAL SANITATION: <br /> State any problems not previously noted: <br /> g, POPULATION DENSITY: <br /> Approximate number of people per square mile: <br />