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--------------- <br /> NOTE: PULL AL ERMITS (Septic, Well, etc.) MAK OPIES FOR FILE <br /> I cFWAGE: <br /> Distance to Public Sewers: J_-J Connection Necessary ? ❑ 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 /> 6 <br /> 1. WATER SUPPLY: <br /> Is Water supplied by Private Well ? 0 Yes D No Is well properly sealed and constructed ? �es No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? F_� Yes EJ-No Is Public Water System Permit current ? Yes No <br /> Does existing or proposed use make this a Public Water System ? 0 Yes No <br /> Is water/well sampling current? F-] Yes ❑ No <br /> Additional information or comments: <br /> GARBAGE& REFUSE: <br /> Licensed scavenger pick-up? EI-Yes ❑ No Service Area No. <br /> Other proposed disposal method: <br /> a <br /> Potential Problem(s): <br /> 4. FLY, MOSQUITO OR VECTOR CONTROL: <br /> Describe potential Vector Control issues: <br /> 5. <br /> IV— <br /> TOILET/ BATH FACILITIES: <br /> Number and Location(s)of existing facilities: <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> GENERALSANITATION: <br /> List any problem(s) not previously noted: <br /> S. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> 06 06 Report#7201 January 22,2008 <br />