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�e � �6T4�rZ MLf .G2Uv�r U" � <br /> r S <br /> NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: - Connection necessary: Yes No e,,- <br /> Does existing septic system comply with San Joaquin County Development Title 4549 <br /> Yes No Unknown ✓ If no, explain: <br /> Describe septic installation to be installed: <br /> A49i A t �` 17 S (> /'A IF <br /> 17 <br /> 2. WATER SUPPLY: � r >"� � �.,n tr�° <br /> Is water supplied by private well: Yes r/ No Is well per: Yes x--' No <br /> State_ -f^cy: 42 d2 <br /> Is well system a Public Water system? Yes No V' Is the permiturrent? Yes No <br /> Does existing or proposed use make this well Public Water: Yes A4 � Is water/well <br /> sampling current: yes No Additional information or comments: 7 <br /> 'e A�f 5 Ar qb <br /> r Z • <br /> 3. GARBIAGtE & REFUSE: <br /> Licensed scavenger pick-up: Yes No Service Area No.: Other proposed <br /> disposal method: <br /> Potential problem(s): <br /> W 2 /t z <br /> 4. FLY,MOSQUITO RO VE C$,T0TENTIAL: T A &.- -� 7-/y �ern :e. <br /> State possible vector potential and necessary control: h 41 6r p 41 p 4 <br /> 5. TOILETBATH FACILITIES: <br /> Number and locations existing: _ 7'� NG *-07cry^ Additional <br /> facilities needed: - <br /> -r A.� p r4W)0__0 s ea AA <br /> 6. PREVIOUS OPERATION HISTORY: <br /> A ' C e i CG <br /> 7. GENERAL SANITATION: U 1�a/ �'/wr d u•�-e.� u <br /> State any problems not previouslN noted: <br /> 8. P N DENSITY: <br /> Approximate number of people per square mile: <br /> EH 06 06 Rev 1/99 f c> > C T`1 L'1 j` rLO I`1 L•e v (� ti /E� C'�f��/ <br /> z // �-a�nC:'' ��`51 op <br />