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1. SEWAGE: too to Public Sewers: Connection necessary: Yes No <br /> Does existing septic system comply with San Joaquin County Qgyvlopment Title Y.549 ? <br /> Yes�— No Unknown If no, explain: a t0 5 4? I j� <br /> Describe septic installation to be installed: <br /> 2. WATER SUPPLY: <br /> Is water suppliedby rivate well- Yes No Is well opgr_YeW/V o <br /> Stat eficie Y:i; � f 1` i <br /> 1 C° <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 /> 3. GARBAGE & REFUSE: <br /> Licensed scavenger pick-up: Yes L--00/No Service h rea No.: Other proposed <br /> disposal method: 04 <br /> Potential problem(s): IVl /© <br /> 4. FLY, MOSQUITO OR VECTOR POTENTIAL: <br /> State possible vector potential and necessary control: <br /> 5. TOILET/BATH FACILITIES: <br /> Number and locations existing: _ � �'�� �s�' -s Additional <br /> facilities needed: <br /> 6. PREVIOUS OPERATION HISTORY: it <br /> 7. GENERAL SANITATION: /jD A <br /> State any problems not previously noted: <br /> S. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br />