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NOTE: PULL ALI. ERMITS (Septic, Well, etc.) MAKFti_,OPIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: X.> 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 ? J�s ❑ No Is well properly sealed and constructed ? Yes ❑ No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? F-1 Yes Ej-No Is Public Water System Permit current ? Ej Yes ❑ No <br /> Does existing or proposed use make this a Public Water System? ❑ Yes ❑ No <br /> Is water/well sampling current ? F-1 Yes ❑ No <br /> Additional information or comments: <br /> 3. GARBAGE& REFUSE: <br /> Licensed scavenger pick-up?/-ED--Yes ❑ 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 /> 5. TOILET/BATH FACILITIES: <br /> Number and Location(s)of existing facilities: wii� i! <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> 7. GENERAL SANITATION: <br /> List any problem(s) not previously noted: <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square m' - <br /> L/ <br /> EH 06 06 Report X7201 <br /> March 07,2006 <br />