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NOTE; PULL Akm,_,,ARMITS (Septic, Well, etc.) M PIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: j�.� Connection Necessary? Yes ® No <br /> Does Existing Septic System comply with San Joaquin County Development Title ? E] Yes No © Unknown <br /> If no,explain: GCJC .//�11-� 7 f�9GfLE, ;�3 eerlu�/ <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well? 11� Yes No Is well properly scaled and constructed ? Ej Yes No <br /> f Describe deficiency,if any: <br /> i <br /> Is well system a Public Water system ? ❑ Yes [2 No Is Public Water System Permit current? Yes ❑ No <br /> Does existing or proposed use;make this a Public Water System ? ❑ Yes Q No <br /> Is water/well sampling current? ❑ Yes ❑ No <br /> Additional information or comments: <br /> 3. GARBAGE& REFUSE: <br /> Licensed scavenger pick-up? 7 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: ��1� <br /> 5. TOILET/BATH FACILITIES: <br /> Number and Location(s)of existing facilities: .r/��J <br /> Additional facilities required: <br /> 1 t <br /> 6. PREVIOUS OPERATION HISTORY: <br /> _ <br /> — <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 Repan#7201 Page 2 June 21,2004 <br /> a <br />