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s � <br /> NOTE: PULL Al,+ERMITS (Septic, Well, etc.) MAKumv4OPIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: Connection Necessary? ❑ Yes No <br /> It <br /> Does Existing Septic System comply with San Joaquin County Development Title? Yes No ❑ Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> IG <br /> i <br /> Ik <br /> 2. WATER SUPPLY: <br /> I!' <br /> Is Water supplied by Private Well ? Eg Yes No Is well properly sealed and constructed ? Q Yes E] No <br /> Describe deficiency,if any: —4y, �,.� �„t,(,( ` getA tek mapYoper <br /> Is well system a Public Water system? ❑ Yes ❑ No [Is Public Water System Permit current? E] Yes ❑ No <br /> Does existing or proposed use make this a Public Water System!? Yes No <br /> Is water/well sampling current? Q Yes ❑ No <br /> Additional information or comments: �k <br /> !6 <br /> H <br /> 3. GARBAGE&REFUSE: V <br /> I <br /> Licensed scavenger pick-up? Q Yes ❑ No Service Area No. <br /> Other proposed disposal method: <br /> Potential Problem(s): <br /> f <br /> 4. FLY,MOSQUITO OR VECTOR CONTROL: <br /> i <br /> Describe potential Vector Control issues: <br /> I° <br /> li <br /> IE <br /> IG <br /> 5. TOILET/BATH FACILITIES: <br /> I� <br /> Number and Location(s)of existing facilities: I? <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> I� <br /> IE <br /> I� <br /> I€ <br /> f <br /> 7. GENERAL SANITATION: <br /> List any problem(s)not previously noted: <br /> I� <br /> S. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> y <br /> I � <br /> EH 06 06 Report#7201 December 07,2005 <br />