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NOTE: PULL ALI ERMITS (Septic, Well, etc.) MAKL._.,OPIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: A-4 Connection Necessary ? E Yes �No /l <br /> Does Existing Septic System comply with San Joaquin County Development Title ? ❑ Yes ❑ No [-,/r 4&khbtn <br /> If no, explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? 17 Yes d No Is well properly sealed and constructed ? Yes No <br /> Describe deficiency, if any: <br /> Is well system a Public Water system ? F—] Yes F7 No Is Public Water System Permit current? Yes No <br /> Does existing or proposed use make this a Public Water System ? E] 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 W No Service Area No. <br /> Other proposed disposal method: <br /> Potential Problem(s): <br /> MOSQUITO OR VECTOR CONTROL: <br /> Describe potential Vector Control issu s: u� <br /> ET/ BATH FACILITIES: <br /> Number and Location(s)of existing facilities: <br /> Additional facilities required: <br /> 'b. PREVIOUS OPERATION HISTORY <br /> 7. GENERAL SANITATION: <br /> List any problem(s) not previously noted: <br /> 8. POPULATION DENSITY: <br /> ApproxiMa <br /> te number of people per square mile: <br /> rt 20 1 October 20.2009 <br />