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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> f <br /> 1. SEWAGE: <br /> Distance to Public Sewers: Connection necessary: Yes No <br /> Does existing septic system comply with San Joaquin County Development Title #549 ? <br /> Yes No Unknown If no. explain: OAA — / a as s <br /> Describe septic installation to be installed: <br /> 2. WATER SUPPLY: / <br /> Is water supplied by private well: Yes No !/ Is well proper: Yes No <br /> State deficiency: WR„i6�6T,yrU <br /> I <br /> Is well system a Public Wa stem? Yes No s the permit current? Yes No <br /> Does existing or proposed use make well c ater: Yes No Is water/well <br /> sampling current: yes No tional information or comments: <br /> 0 <br /> 3. GARBAGE & REFUSE: <br /> Licensed scavenger pick-up: Yes No Service Area No.: Other proposed <br /> disposal method: <br /> Potential problem(s): No�u <br /> s <br /> 4. FLY, MOSQUITO OR VECTOR POTENTIAL: <br /> State possible vector potential and necessary control: 0 4A)&,E <br /> 5. TOILET/BATH FACILITIES: I <br /> Number and Iocations existing: _� _ Additional <br /> facilities needed: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> 7. GENERAL SANITATION: <br /> State any problems not previously noted: d <br /> S. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> Ell 06 06 Rev 1/99 <br /> is <br />