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NOTE: PULL A' .ERMITS (Se;tic, Well, etc.) MAK1F flP1ES FOR FRE <br /> 1. SEWAGE: <br /> Ofinection Necessary? Yes ❑ No <br /> Distance to Public Sewers: IIII <br /> Does Existing Septic System comply with San Joaquin CO'Lnty Development Title? ❑ Yes ❑ No ❑ Unknown <br /> IU <br /> If no,explain: I <br /> Describe Septic System to be installed: �u <br /> I! <br /> �u <br /> Z. WATER SUPPLY: <br /> I <br /> Is Water supplied by Private Well? 0 Yes E] No Is well properly scaled and constructed? ❑ Yes ❑ No <br /> Describe deficiency,if any: I _— <br /> lll <br /> Is well system a Public Water system? ❑ Yes ❑ No Is Public Water System Permit current? E] Yes ❑ No <br /> Does existing or proposed use make this a Public Water'ystem? ❑ Yes ❑ No <br /> Is water/well sampling current? ❑ Yes ❑ NolI <br /> Additional information or comments: <br /> 3. GARBAGE & REFUSE: <br /> Licensed scavenger pick-up? ❑ Yes ❑ No Service Area No. <br /> Other proposed disposal method: <br /> Potential Problem(s): <br /> f IIII <br /> 4. FLY MOS UITO OR VECTOR CONTROL: <br /> Describe potential Vector Control issues: II I <br /> ul� <br /> 5. TOILET 1 BATH FACILITIES: ! <br /> i <br /> Number and Location(s)of existing facilities: I <br /> Additional facilities required: fu <br /> ' I <br /> 6. PREVIOUS OPERATION HISTORY: I i <br /> � j <br /> ill <br /> III <br /> 7. GENERAL SANITATION: <br /> List any problem(s) not previously noted i i <br /> �u <br /> ; i <br /> 8. POPULATION DENSITY: I <br /> Approximate number of people per square mile: <br /> I � <br /> EH 06 06 Report 47201 i Page 2 lune 21,2004 <br /> il - <br /> I <br />