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NOTE, PULL ALL RMITS (Septic, Well, etc.) MAKE ,-PIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: /� _ Connection Necessary ? ❑ Yes ❑ No <br /> Does Existing Septic System comply with San Joaquin County Development Title ? E 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 ? dYes ❑ No Is well properly sealed and constructed ? dYes [:] No <br /> Describe deficiency,if any: <br /> Is well system a Publi ater system ? Yes � No Is Public Water System Permit current? Yes ❑ No <br /> Does existing propo d use make this a Public Water System ? Yes No <br /> Is water I we mg current ? ❑ Yes No <br /> Additional information or comments: <br /> 3. GARBAGE& REFUSE: <br /> Licensed scavenger pick-up? Yes ❑ No Service Area No. <br /> Other proposed disposal method: <br /> Potential Problem(s): <br /> 4. FLY,MOSOUITO OR VECTOR CONTROL: <br /> Describe potential Vector Control issues: C� <br /> 22 Llll�_eoL <br /> S. TOILET/BATH FACILITIES: <br /> Number and Location(s)of existing facilities; ��. ✓. " ¢' f <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> 7. GENERAL SANITATION: <br /> List any problem(s) not previously noted: <br /> S. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> H 06 06 Report#17201 June 13,2007 <br />