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NOTE: PULL ALL,_ 'RMITS (Septic, Well, etc.) MAKE _)PIES FOR FIL <br /> 1. SEWAGE: <br /> Distance to Public Sewers: aQr Connection Necessary ? E] Yes No <br /> Does Existing Septic System comply with San Joaquin County Development Title? Yes No Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? F-1 Yes ENo Is well properly sealed and constructed ? ❑ Yes No <br /> Describe deficiency, if any: <br /> Is well system a Public Water system ?4 Yes F-1 No Is Public Water System Permit current ? Yes 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 R REFUSE: <br /> Licensed scavenger pick-up? 4 acs No Service Area No. <br /> Other proposed disposal method: <br /> Potential Problem(s): <br /> FLY.MOSOUITO OR VECTOR CONTROL: <br /> Ce ntial Vector Control issues: �y�TH FACILITIES: <br /> Number and Location(s) of existing facilities: /�i• wi�i / <br /> Additional facilities required: <br /> A. PREVIOUS OPERATION HISTORY: <br /> 7. GENERAL SANITATION: <br /> List any problem(s) not previously noted: -2S,� <br /> POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> 0606 Report#7201 <br />