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J ♦. �ti <br /> NOTE: PULL;i. 'IERMITS (Septic, Well, etc.) MAk6wobPIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: Connection Necessary? f--j Yes ff No <br /> Does Existing Septic System comply with San Joaquin County Development Title? Yes F-1 No Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well? dYes F] No Is well properly sealed and constructed ? aYes ❑ No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system? Yes t No Is Public Water System Permit current? E] Yes Ej No <br /> Does existing or proposed use make this a Public Water System ? [—] Yes No <br /> Is_water/well sampling current? ❑ Yes F-1 No <br /> Additional information or comments: <br /> 3. GARBAGE&REFUSE: <br /> Licensed scavenger pick-up? F-1 Yes F-1 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: T �/ <br /> 5. TOILET 1 BATH FACILITIES: <br /> Number and Location(s)of existing facilities: <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> 7. GENERAL SANITATION: <br /> List any problem(s)not previously noted: <br /> S. POPULATION DENSITY: <br /> Approximate number of people per square mile: Z11/JJa� <br /> EH 06 06 Report 47201 June 15,2005 <br />