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NOTE: PULL ALI. :RMITS (Septic, Well, etc.) MAKE PIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: Connection Necessary ? ❑ Yes No <br /> Does Existing Septic System comply with San Joaquin County Development Title? Yes No Q Unknown <br /> If no,explain: Z;rL-lt s% / /AZ�Lfh C���r1/�t5.5�7i� SLQ�➢oJ�<c6 <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well? Yes 0 No Is well properly sealed and constructed ? [Z Yes No <br /> Describe deficiency, if any: <br /> Is well system a Public Water system ? F-] Yes M No Is Public Water System Permit current ? E] Yes No <br /> Does existing or proposed use make this a Public Water System ? 7 Yes No <br /> Is water/well sampling current ? [] Yes F_� No <br /> Additional information or comments: <br /> 3. GARBAGE& REFUSE: <br /> Licensed scavenger pick-up? F-] 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: A1114 <br /> 5. TOILET/ BATH FACILITIES: <br /> Number and Location(s)of existing facilities: <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> ,AG. <br /> 7. GENERAL SANITATION: <br /> List any problem(s) not previously noted /// <br /> S. POPULATION DENSITY: <br /> Approximate number of people per square mile: (X5&Cj- 6e.1/ <br /> EH 06 06 Report 97201 Page 2 June 21 2004 <br />