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NOTE: PULL ALL, ?RMITS (Septic, Well, etc.) MAKE _ )PIES FOR FILE <br /> SEWAGE: <br /> Distance to Public Sewers: a'Cb Connection Necessary ? E Yes ❑ 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 /> WATER SUPPLY: <br /> Is Water supplied by Private Well ? El Yes Q No Is well properly sealed and constructed ? Yes E] No <br /> Describe deficiency, if any: <br /> Is well system a Public Water system ? F-1 Yes -E No Is Public Water System Permit current ? Yes No <br /> Does existing or proposed use make this a Public Water System ? Ej Yes No <br /> Is water/well sampling current ? F— Yes F-1 No <br /> Additional information or comments: <br /> GARBAGE & REFUSE: <br /> Licensed scavenger pick-up? 0 Yes No Service Area No. : - <br /> Other proposed disposal method: <br /> Potential Problem(s): <br /> FLY, MOSQUITO OR VECTOR CON"ROL: <br /> Describe potential Vector Control issues ` .. <br /> TOILET/ BATH FACILITIES: <br /> Number and Location(s)of existing facilities:. <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> GENERAL SANITATION: <br /> List any problems) not previously noted: <br /> POPULATION DENSITY: <br /> Approximate number of people per square mile: /%� <br /> 06 Report 47201 ah r .4Z <br />