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NOTE: PULL ALI IRMITS (Septic, Well, etc.) MAKE PIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: /U Connection Necessar. ' E-1 Yes 0 No <br /> Does Existing Septic System comply with San Joaquin County Development Title '! O Yes ❑ NosQ Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> WATER SLIPPLI': <br /> Is Water supplied b.% Private Well ? F—] Yes F-1 No Is well properly sealed and constructed ? E Y es 11 No <br /> Describe deficiency, if any: <br /> Is well system a Public Water system ? F-� 1'e, F-1 No Is Public Water System Permit current '? Yes E] No <br /> Does existing or proposed use make this a Public Water System ? ❑ Yes No <br /> Is water i well sampling current ? E-1 Yes No <br /> Additional information or comments: <br /> GARBAGE& REFUSE: <br /> Licensed scavenger pick-up? EVYes4M Service Area No. : _ <br /> Other proposed disposal method: <br /> Potential Problem(s): <br /> 4. FLY MOS UITO OR Y ECJ OR CONTRO <br /> Describe potential Vector Control issues: <br /> 5. TOILET / BATH FACILITIES: <br /> Number and Location(s) of existing facilities! J�� <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <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 /> D!06 06 Repon 07201 _ <br />