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NOTE: PULL ALL%wtRMITS (Septic, Well, etc.) MAKEPIES FOR FILE <br /> — <br /> I. SEWAGE: <br /> Distance to Public Sewers: Connection Necessary? ❑ Yes r-1 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 /> f <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? ❑ Yes E] 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? [j Yes No <br /> Does existing or proposed use make this a Public Water System ? Ej Yes No <br /> Is water/well sampling current? ❑ Yes ❑ No i <br /> Additional information or comments: <br /> 3. GARBAGE& REFUSE: <br /> Licensed scavenger pick-up? ❑ Yes r-1 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: <br /> S. TOILET/BATH FACILITIES: <br /> Number and Location(s)of existing facilities: i <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> f <br /> 7. GENERAL SANITATION: <br /> List any problem(s) not previously noted: j <br /> S. POPULATION DENSITY: <br /> if <br /> Approximate number of people per square mile: <br /> I <br /> 106 06 Report 47201 9 <br /> dune 01,2007 { <br />