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NOTE: PULL ALL. RMITS (Septic, Well, etc.) MAKE PIES FOR FILE �~ <br /> I. SEWAGE: <br /> Distance to Public Sewers: Connection Necessary ? F-1 Yes ❑ No <br /> Does Existing Septic System comply with San 3oaquin County Development Title ? �.Yes M 1/�]0/ Ej Unknown <br /> If no,explain: Yt , `� .1' ✓ f.(.w�¢ � 11L9n v��+t -,mac .,i.rc rvy <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? [aYes No Is well properly sealed_and constr-uctsed ? Ej Yes La-No <br /> Describe deficiency,if any: � � SSC !ilGL'o/CoQ ��I rou} hC�c.�• a�`� .5� <br /> Is well system a Public Water system ? F-� Yes No Is Public Water System Permit current ? ❑ Yes ❑ No <br /> Does existing or proposed use make this a Public Water System ? F-1 Yes F-1 No <br /> Is water/well sampling current ? F-1 Yes ❑ No <br /> Additional information or comments: <br /> 3. GARBAGE& REFUSE: <br /> Licensed scavenger pick-up? F-1 Yes ❑ 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: <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> 7. GENERAL SANITATION: <br /> List any problem(s) not previously noted: <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> EH 06 06 Repon#7201 January 30,2007 <br />