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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MADE COPIES FOR FILI - <br /> 1. SEWAGE: <br /> Distance to Public Sewers: Connection necessarv: Yes No4� <br /> Does existing septic system comply with San Joaquin County Development Title 4549 ? <br /> Yes No Unknown If no, explain: <br /> De ins <br /> -� <br /> 2. WATER SUPPLY: � .. <br /> Is water supplied by private well: Yes No Is well proper: Yes !! No <br /> State deficiency: <br /> 1 <br /> Is well system a Public Water system? Yes No ' Is the permit c:��Is <br /> s No <br /> Does existing or proposed use make this well Public Water: Yes No water/well <br /> sampling current: yes No Additional information or comments: :9 !!V_ 43 �V Ac-�� <br /> 5-1;2 a.a v - e, l Tt — L ►.,/ <br /> 3. GARBAGE & REFUSE: <br /> Licensed scavenger pick-up: Yes No Service Area No.: Other proposed <br /> disposal method: <br /> Potential problem(s): <br /> 4. FLY MOSQUITO OR VECTOR POTENTIAL: <br /> State possible vector potential and necessary control- <br /> . , <br /> 5. TOILET/BATH FACILITIES: <br /> Number and locations existing: Additional <br /> facilities needed: <br /> 6. PREVIOUS OPERATION HISTOR <br /> pit; a�� <br /> 1 i <br /> 7. GENERAL SANITATION: <br /> State any problems not previously noted: �r <br /> Ilf 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> i <br /> EH 06 06 Rev 1/99 <br />