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NOTE: PULL ALL—ARMITS (Septic, Well, etc.) MAKit- dOPIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public'Sewers: �� Connection Necessary? 0 Yes © No <br /> Does Existing Septic System comply with San Joaquin County Development Title? Yes E]' No ❑ Unknown <br /> If no,explain:_ <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> i <br /> Is Water supplied by Private Well? F7[--fes 0 No Is well properly sealed and constructed ? El Yes ❑ No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system? ❑ Yes fD—No Is Public Water System Permit current? ❑ Yes -E] 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? Pq--Ves No Service Area No. <br /> Other proposed disposal method: <br /> i <br /> Potential Problem(s): <br /> 4. FLY,MOSQUITO OR VECTOR CONTROL: <br /> Describe potential Vector Control issues: /,. C)ZZ:: �yy <br /> 5. TOILET/BATH FACILITIES: <br /> Number and Location(s)of existing facilities: �.����,�j� l <br /> Additional facilities required: <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 /> I <br />