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NOTE: PULL ALL PER*1T (SEPTIC, WELL, ETC...) MAKE COPIES 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 #549 ? <br /> Yes No Unknown �X If no, explain: <br /> Describe septic installation to be installed: <br /> 2. WATER SUPPLY: AJ a <br /> Is water supplied by private well: Yes No Is well proper: Yes No <br /> State deficiency: <br /> Is well system a Public Water system? Yes No Is the permit current? Yes No <br /> Does existing or proposed use make this well Public Water: Yes No Is water/well <br /> sampling current: yes No Additional information or comments: <br /> 3. GARBAGE & REFUSE: <br /> Licensed scavenger pick-up: Yes No Service Area No.: Other proposed <br /> disposal method: <br /> Potential problem(s): <br /> 4. FLY, MOSQUITO OR VECTOR POTENTIAL: _- <br /> State possible vector potential and necessary control: <br /> 5. TOILETBATH FACILITIES: <br /> Number and locations existing: Additional <br /> facilities needed: <br /> 6. PREVIOUS OPERATKIN HISTORY: 't <br /> • ♦ ✓G I'�f <br /> 42 an&=w2 <br /> d <br /> 7. GENERAL SANITATION: <br /> State any problems not previously noted- <br /> 8. <br /> oted8. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> .�<_ ( Ge ( 1 Wtr`. *vim Y '- r ure. <br /> EH 06 06 Rev 1/99 �(f 1 l w kp <br /> I y <br />