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NOTE: PULL A~PERMITS (Septic, Well, etc.) MAKMOP1ES FOR FILE <br /> I. SEWAGE: <br /> Distance to Public Severs: t, -fir Connection Necessary ? El Yes E No <br /> Does Existing Septic System comply with San Joaquin County Development Title? E'Yes F—] No M Unknown <br /> If no, explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? Yes No Is well properly sealed and constructed ? F—] Yes No <br /> Describe deficiency, if any: ; ' <br /> Nti <br /> .Is well system a Public 'Vater system ? F—] Yes F-3,/No Is Public Water System Permit current? Yes No <br /> Does existing or proposed use make this a Public Water System? F—] Yes No <br /> Is water/well sampling current? ❑ Yes ❑ No <br /> Additional infortnation or comments: <br /> 3. GARBAGE & REFUSE: <br /> Licensed scavenger pick-up? D 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 /> S. TOILET/BATH FACILITIES: <br /> Number and Location(s)of existing facilities: <br /> Additional facilities required: <br /> b- 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 miler <br /> 06 06 Repoit 77(11 <br /> 3Line 2 ,201C <br />