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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC—) MAKE COPIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: / Connection necessary: Yes No <br /> Does existing septic system comply with San Joaquin County Development Title 9549 ? <br /> Yes No Unknow If no, explain: <br /> Describe septic installation to be installed: <br /> 2. WATER SUPPLY: <br /> Is water supplied by private well: Yes X No Is well proper: Yeses No <br /> State deficiency: <br /> em? Ye the permit current? Yes No <br /> Is well system a Public Water cyst s No Is <br /> Does existing or proposed use make this well Public Water: Yes No Is water/well <br /> sampling current: yes No Additional information or comments: <br /> 3. GARBAGE & REFUSE: <br /> Licensed scavenger pick-up: Yes No }C Service Area No.: Other proposed <br /> disposal method: <br /> Potential problem(s): <br /> 4. FLY, MOSQUITO OR VECTOR POTENTIAL: <br /> State possible vector potential and necessary control: /Uy41 G <br /> 5. TOILET/BATH FACILITIES: <br /> Number and locations existing: 7`Wo pF1'r ff 5 Additional <br /> facilities needed: AVU: 0, T14 40 fir'+ Krcr <br /> 6. PREVIOUS OPERATION HISTORY: <br /> S 1 be,N 0 E <br /> 7. GENERAL SANITATION: <br /> State any problems not previously noted: /(/O R)6- <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> FH 06 06 Rev 5/99 <br />