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w, <br /> NOTE: PULL ALL RMITS (Septic, Well, etc.) MAK PIES FOR PILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: A'1r1y4 <br /> Connection Necessary? ❑ 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 /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well? Yes F-1NoIs well properly scaled and constructed? Yes ❑ No <br /> 011 <br /> Describe deficiency,if any: OF <br /> Is well system a Public Water system? E] Yes ❑ No Is Public Water System Permit current? ❑ Yes ❑ No <br /> Does existing or proposed use make this a Public Water System? ❑ Yes ❑ No <br /> Do p p <br /> g <br /> Is water 1 well sampling current? ❑ Yes ❑ No <br /> Additional information or comments: <br /> 3. GARBAGE&REFUSE: <br /> Licensed scavenger pick-up? ❑ Yes ❑ No Service Area No. : <br /> Other proposed disposal method: <br /> Potential Problem(s): <br /> 4. FLY MOS UITO OR VECTOR CONTROL: <br /> 3 Describe potential Vector Control issues: <br /> S. TOILET 1 BATH FACILITIES: <br /> Number and Location(s)of existing facilities: <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> i <br /> a <br /> 7. GENERAL SANITATION: <br /> List any problem(s)not previously noted <br /> i 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> r <br /> EH 06 06 Report#7201 Page l May 12,2004 <br /> i <br />