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} <br /> NOTE: PULL AL ERMITS (Septic, Well, etc.) MAKE.,,hPIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: /A111,4 Connection Necessary? Yes No <br /> Does Existing Septic System comply with San Joaquin County Development Title ? Yes No <br /> If no,explain: <br /> Describe Septic System to be installed: ' <br /> h <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well? [Z Yes No Is well properly sealed and constructed ? Yes No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? 0 Yes No Is Public Water System Permit current? Yes No <br /> Does existing or proposed use make this a.Public Water System? :�. Yes. fy No <br /> Is water 1 well sampling current ? E] Yes No <br /> Additional information or comments: <br /> A;. <br /> 3. GARBAGE& REFUSE <br /> Licensed scavenger pick-up? Yes Q:No . ,f.;Service Area No. : <br /> Other proposed disposal,method: <br /> Potential Problem(s): t <br /> a. FLY, MOSQUITO. OR VECTOR CONTROL: <br /> Describe potential Vector Control issues: ' <br /> 5. TOILET/BATH FACILITIES: <br /> Number and Location(s)of existing facilities: <br /> Additional facilities required: <br /> 6• PREVIOUS OPERATION HISTORY; <br /> s <br /> 7. GENERAL SANITATION: , <br /> r` N <br /> List any problem(s)not previously noted <br /> S. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> Edi 06 06 Report#7201 Page 2 June 21,2004 <br /> -,z <br />