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NOTE: PULL ALL ERMITS (Septic, Well, etc.) MAKOIII PIES FOR FILE <br /> I. SEWAGE: <br /> Distance to Public Sewers: 7C200- Connection Necessary ? E yes 2No <br /> I <br /> Does Existing Septic System comply with San Joaquin County Development Title? Y.s F-1 No Ej Unknown <br /> If no, explain: <br /> Describe Septic System to be installed: <br /> I <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? ❑ Yes E� No Is well properly sealed and constructed ? ❑ Yes [-] No <br /> Describe deficiency, if any: <br /> Is well system a Public Water system ? ❑ Yes �No Is Public Water System Permit current? Yes F-1 No <br /> Does existing or proposed use make this a Public Water System ? E] Yes ❑ No <br /> Is water/well sampling current ? ❑ Yes ❑ No <br /> Additional information or continents: <br /> �I <br /> 3. GARBAGE& REFUSE: <br /> Licensed scavenger pick-up? Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential Problem(s): <br /> 4. FLY MOSQUITO OR VECTOR CONTROL: <br /> Describe potential Vector Control issues: <br /> 5. TOILET/BATH FACILITIES: <br /> Number and Location(s)of existing facilities: ef <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> -: 1W e- S <br /> 7. GENERAL SANITATION: <br /> List any problem(s)not previously noted: <br /> S. POPULATION DENSITY: <br /> Approximate number of people per square mile: •�Cx.� , <br /> :H 06 06 Report 47201 April 11,2008 <br />