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I <br /> NOTE: PULL ALL�,,;RMITS (Septic, Well etc. � 5 <br /> I. SE`WAGE; � � MAKE +PIES FOR FILE <br /> Distance to Public Sewers: <br /> Connection Necessary? El yes ❑ No <br /> Does Existing Septic System comply with San Joaquin County Development Title ? <br /> If no,explain: ❑ yes ❑ No ❑ Unknown <br /> Describe Septic System to be installed: <br /> Z• WATER SUPPLY: <br /> Is Water supplied by Private Well ? ❑ Yes ❑ No Is well properly scaled and constructed ? ❑ yes ❑ No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? [:1 Yes ❑ No Is Public Water System Permit current? <br /> Does existing or proposed use make this a Public Water System ?E] ❑ ❑ Yes E] No <br /> Is water/well sampling current ? Yes ❑ No <br /> Additional information or comments: ❑ No ye5 1 <br /> 3. GARBAGE&REFUSE.• <br /> Licensed scavenger pick-up? <br /> ❑ Yes No❑ Service Area No. <br /> Other proposed disposal method: <br /> Potential Problem(s): <br /> { <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 /> f <br /> 7. GENERAL SANITATION• <br /> List any problem(s) not previously noted: <br /> i <br /> 8. POPULATION DENSITY• <br /> I <br /> Approximate number of people per square mile: <br /> 106 06 Report 47201 �I <br /> April 11,2007 )� <br /> I <br /> w <br />