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NOTE: PULL ALL--=RMITS (Septic, Well, etc.) MAKE CUPIES FOR FILE <br /> AGE: <br /> Distance to Public Sewers: Connection Necessary ? ❑ Yes [J�No <br /> Does Existing Septic System comply with San Joaquin County Development Title? Yes ❑ No Unknow <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> *ATER SUPPLY: <br /> Is Water supplied by Private Well ? ayes [] No Is well properly sealed and constructed ? /2/Yes ❑ <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? E] Yes L2-No Is Public Water System Permit current? Lj e9 <br /> Does existing or proposed use make this a Public Water System? [:] Yes E] No <br /> Is water/well sampling current? F-1 Yes F-1 No <br /> Additional information or comments: <br /> GARBAGE&REFUSE: <br /> Licensed scavenger pick-up? Yes ❑ No Service Area No. <br /> Other proposed disposal method: <br /> Potential Problem(s): -46� <br /> FLY,MOSQUITO OR VECTOR CONTROL: <br /> Describe potential Vector Control issues: p <br /> 5. TOILET/BATH FACILITIES: <br /> Number and Location(s)of existing facilities: <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> l <br /> GENERAL SANITATION: <br /> ist any problems)not previously noted: <br /> POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> "_H 06 06 Report#7201 <br /> M2`:_'2. 'UU4 <br />