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NOTE: PULL ALI,�_£RMITS (Septic, Well, etc.) MAKL-JOP1ES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: _ Connection Necessary ? ❑ Yes Q 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? EEr Yes F-1 No Is well properly sealed and constructed ? EaYes E No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? F-� Yes © No Is Public Water System Permit current ? Yes No <br /> Does existing or proposed use make this a Public Water System ? ❑ Yes F,�j No <br /> Is water/well sampling current? [7 Yes No <br /> Additional information or comments: <br /> 3. GARBAGE & REFUSE: <br /> Licensed scavenger pick-up? E-1 Y es 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: Nei <br /> —r <br /> 5. TOILET/ BATH FACILITIES: <br /> Number and Location(s)of existing facilities: <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> co'��P� <br /> 7. GENERAL SANITATION: <br /> List any problem(s) not previously noted: Z4 <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: /�i✓Ji7J o�g7�Z/ , <br /> EH 9606 Report#7201 Fcbruan <br />