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NOTE: PULL AL 'ERMITS (Septic, Well, etc.) MAN. _ :OPIES FOR FILE <br /> SEWAGE: <br /> Distance to Public Sewers: �a �� Connection Necessary ? Yes No <br /> Does Existing Septic System comply with San Joaquin County Development Title ? Yes No Unkno <br /> If no,explain: <br /> Describe Septic System to he installed: <br /> WATER SUPPLY: <br /> Is Water supplied by Private Well ? EI-Yes ❑ No Is well properly sealed and constructed ? ®'Yes 0 N ' <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? f]�"Yes F] No Is Public Water System Permit current ? n Yes E No <br /> Does existing or proposed use make this a Public Water System ? ❑ Yes No <br /> Is water/well sampling current ? F-] Yes F-1 No <br /> Additional information or comments: <br /> WL <br /> or <br /> GARBAGE& REFUSE: <br /> Licensed scavenger pick-up? Eq--res F-1 No Service Area No. <br /> Other proposed disposal method: <br /> Potential Problem(s): <br /> FLY,MOSQUITO OR VECTOR CONTROL: <br /> Describe potential Vector Control issues: <br /> 5. TOILET/BATH FACILITIES: <br /> Number and Location(s)of existing facilities: o.�ii��rSi <br /> Additional facilities required: <br /> . PREVIOUS OPERATION HISTORY: , <br /> 9. GENERAL SANITATION: <br /> List any problem(s) not previously noted: <br /> S. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> EH 06 06 Repon#7201 hi h ';,2nnx <br />