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NOTE. PULL Al.. �ERMITS (Septic, Well, etc.) MAK OPIES FOR FILE <br /> I. SEWAGE: <br /> Distance to Public Sewers: Connection Necessary? ❑ Yes LY__I No <br /> Does Existing Septic System comply with San Joaquin County Development Title? dYes ❑ No ❑ Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? li�Ycs No Is well properly sealed and constructed ? Yes r-] No <br /> Describe deficiency, if any: <br /> Is well system a Public Water system ? 0 Yes Ej�No Is Public Water VScm Permit current? Yes F-1 No <br /> Does existing or proposed use make this a Public Water System ? ❑ Yes No <br /> Is water/well sampling current? ❑ Yes No <br /> Additional information or comments: <br /> 3. GARBAGE& REFUSE: <br /> Licensed scavenger pick-up? dYes ❑ 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: 00, <br /> �{�] —��J ��✓� <br /> Additional facilities required: <br /> 6. PREVIODUS OPERATION HISTORY: <br /> -2 e— <br /> 7. GENERAL SANITATION: <br /> List any problem(s)not previously noted: At <br /> S. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> 1;H 06 06 Report#7201 <br /> October 16,2009 <br />