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NOTE: PULL AL ERMITS (Septic, Well, etc.) MAKE-COPIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: �- 'Ly <br /> )0 Connection Necessary ? Yes No <br /> //(A <br /> Does Existing Septic System comply with San Joaquin County Development Title ? Yes No 1Z Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? ❑ Yes Ea/No Is well properly sealed and constructed ? Yes No <br /> Describe deficiency, if any: <br /> Is well system a Public Water system ? ❑ Yes D No Is Public Water System Permit current? Yes No <br /> Does existing or proposed use make this a Public Water System ? F-1 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? Yes F-� 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: <;-ewo �.v<rsJi6 ifi /fiLS , 1€ C 07f� h/�i�lC2 f� <br /> ��1,✓.Q�2,PJ21.� <br /> 5. TOILET/BATH FACILITIES: <br /> Number and Location(s)of existing facilities: A414 <br /> Additional facilities required: /►x-11 <br /> 6. PREVIOUS OPERATION HISTORY: <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 47201 August 26,2005 <br />