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i <br /> NOTE: PULL AL' ERMITS (Septic, Well, etc.) MAKErIP1ES FOR FILE _ t <br /> 1. SEWAGE: <br /> 'I <br /> Distance to Public Sewers: /A11A Connection Necessary? Yes No �� <br /> Does Existing Septic System comply with San Joaquin County Development Title ? E] Yes E] No ,� <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> f <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well? © Yes No Is well properly sealed and constructed ? EfYes No <br /> Describe deficiency, if any: GlX�Z , /r/ w <br /> Is well system a Public Water system ? ❑ Yes No Is Public Water System Permit current? ❑ Yes ❑ No <br /> Does existing or proposed use make this a.Public.Water System ?. Q, Yes, [YNo <br /> Is water 1 well sampling current? M Yes No y <br /> Additional information or comments: <br /> 3. GARBAGE & REFUSE: i • .. +:,z .s yc " .�� . ; ,* �. <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:_)1}' <br /> S. TOILET/BATH FACILITIES: <br /> Number and Location(s)of existing facilities: D� X'//c� Z <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: i . <br /> �5 <br /> 7. GENERAL SANITATION: . <br /> List any problem(s)not previously noted <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> EH 06 06 Report 117201 Page 2 June 21,2004 <br />