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NOTE: PULL AL ERMITS (Septic, Well, etc.) MAK. _ OPIES FOR FILE <br /> 1. SEWAGE: -- ((// <br /> Distance to Public Sewers: rY� Connection Necessary ? F-] Yes No <br /> Does Existing Septic System comply with San Joaquin County Development Title ? F-1 Yes F-] No F-1 Unknown <br /> [f no, explain: <br /> Describe Septic System to he installed: <br /> . WATER SUPPLY: <br /> Is Water supplied by Private Well ? � Yes 0 No Is well properly sealed and constructed 7 � Yes � No <br /> JDescribe deficiency,if any: <br /> Is well system a Public Water system ? ❑ Yes � No Is Public Water System Permit current ? Yes No <br /> Does existing or proposed use make this a Public Water System ? Yes �✓ No <br /> Is water/well sampling current ? F Yes No <br /> Additional information or comments: <br /> GARBAGE &REFUSE: <br /> Licensed scavenger pick-up? [2 Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential Problem(s): <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 /> L <br /> 7. GENERAL SANITATION: <br /> List any problem(s) not previously noted: <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: (,�/lam✓Q � <br /> FH 06 06 Repon N7201 May 06.2008 <br />