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NOTE: PUL'L ALL PEh.VHTS (SEPTIC, WELL, E :T'MAKE COPIES FOR FILE <br /> r° ?- 5C:jP%j i >l-'/'ems <br /> SEWAGE: <br /> Distance to Public Sewers: Connection necessary: Yes No.A—: <br /> Does exi mg septic system comply with San Joaquin County Development Title #549 ? <br /> Yes No Unknown If no, explain: <br /> Describe septic installation to be installed: <br /> 2. WATER SUPPLY: /0 d' l - <br /> Is water supplied by pnvate well: Yeses No Is well proper: Yes_ No <br /> State deficiency: <br /> Is well system a Public Water system? Yes No Is the permit current? Yes No <br /> Does existing or proposed use make this well Public Water: Yes No Is water/well <br /> sampling current: yes No Additional information or comments: 7 A 2 <br /> 3r <br /> TSS o () r—ALf i.«.c S <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: '0 L S <br /> State possible yeqtor potential and necessary control: 2 4P <br /> 4A (04nnZi&of <br /> oze,8 8rr Alv- (U37 Cern. vs �' � :��� <br /> S. —OILET/BATH FACILITIES: yt� y� K�(� 5� y� s <br /> Number and locations existing: f Additional <br /> facilities needed: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> 7. GENERAL SANITATION: r4' ` <br /> State any problems not previously noted: <br /> 8. POPULATION DENSITY: �. <br /> Approximate number of people per square mile: <br /> % S z /"S v a s <br /> 6 .t LM S 4r S T P�• �rp./C% E X r s > + c� , ; fid,,, <br /> ,IV o ,/ �A <br /> EH 06 06 Rev 1199 <br />