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' NOTE: PULL.AL rERMITS (Septic, Well, etc.) MAKB40PIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: ;y Connection Necessary? ❑ Yes No <br /> Does Existing Septic System comply with San Joaquin County Development Title? Fj 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 F-� No Is well properly sealed and constructed ? E es [;]--No <br /> Describe deficiency,if any: Ct2:��� Q&a6 �►d � �, � 12— ::;"L <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? ❑ Yes F-� No <br /> Is water 1 well sampling current? ❑ Yes No <br /> Additional information or comments: <br /> 3. GARBAGE& REFUSE: <br /> Licensed scavenger pick-up? F71 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: <br /> 5. TOILET 1 BATH FACILITIES: <br /> Number and Location(s)of existing facilities: ,3y���r <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> r <br /> i <br /> k <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#7201 December 01,2008 <br />