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NOTE: PULL ALE.--_2RMITS (Septic, Well, etc.) MAKE—.,OPIES FOR FILE <br /> 1. SEWAGE: �77� <br /> / Necessary ? [D ❑ <br /> Distance to Public Sewers: �a� Connection Necessa es 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 -tEj No Is well properly sealed and constructed ? ❑ Yes ❑ No <br /> Describe deficiency,if any: <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 ❑ No <br /> Is water/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: 2; <br /> 5. TOILET/BATH FACILITIES: <br /> Number and Location(s)of existing facilities: ����„y-�� <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> OAS iiri/.m7li/�/ �/i�' <br /> t <br /> 7. GENERAL SANITATION: <br /> List any problem(s)not previously noted <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square milt;** <br /> EH 06 06 Report x7201 Page 2 June 21,2004 <br />