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NOTE: PULL AL RMITS (Septic, Well, etc.) MAKE OPIES FOR FILE <br /> 1. SEWAGE: <br /> Connection <br /> Distance to Public Sewers: Necessary? Yes ©'No <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 /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? Yes ❑ No Is well properly sealed and constructed ? Yes ❑ No <br /> Describe deficiency, if any: <br /> is well system a Public Water system? ❑ Yes LjNo Is Public Water System Permit current? Yes ❑ No <br /> Does existing or proposed use make this a Public Water System? ❑ Yes No <br /> Is water 1 well sampling current? ❑ Yes ❑ No <br /> Additional information or comments: <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: 1-`114 <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 <br /> ENSITY:A roximate number of people per square mile: ` <br /> f:H 06 06 Report 47201 May 10.2010 <br />