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NOTE: PULL ALI ERMITS (Septic, Well, etc.) MAKE OPIES FOR FILE 1 <br /> 1. SEWAGE: <br /> Distance to Public Sewers: Connection Necessary ? 0 Yes No <br /> Does Existing Septic System comply with San Joaquin County Development Title? Yes F—] No Unknown <br /> F If no, explain: <br /> Describe Septic System to be installed: <br /> • WATER SUPPLY: <br /> Is Water supplied by Private Well ? Yes No Is well properly sealed and constructed ? Yes o <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? F-1 Yes F—] No Is Public Water System Permit current ? Yes No <br /> Does existing or proposed use make this a Public Water System ? ❑ Yes F] No <br /> Is water/well sampling current ? F� Yes F—] No <br /> # Additional information or comments: <br /> 3. GARBAGE& REFUSE: - .- <br /> Licensed scavenger pick-up? F� Yes No Service Area No. <br /> Other proposed disposal meth <br /> Potential Problem(s): <br /> 4. FLY,MOSOUITO OR VECTOR CONTROL: <br /> Describe potential Vector Control issues: <br /> 5. TOILET/BATH FACILITIES: <br /> Number and Location(s)of existing facilities: 1. l <br /> Additional facilities required: <br /> 6• PREVIOUS OPERATION HISTORY: <br /> Am <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 /> ti 06 06 Report 47201 <br />