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NOTE: PULL ALL 'RMITS (Septic, Well, etc.) MAKE )PIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: .G3- Connection Necessary ? ❑ Yes No <br /> Does Existing Septic System comply with San Joaquin County Development Title ? No.No � h+dal�m-n <br /> If no, explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? ❑ Yes allo Is well properly sealed and constructed ? ❑ Yes ❑ No <br /> Describe deficiency, if any: <br /> Is well system a Public Water system ? F-1 Yes ❑ No Is Public Water System Permit current ° E] Yes ❑ No <br /> Does existing or proposed use make this a Public Water System ? Yes No <br /> Is water/well sampling current ? F-1 Yes ❑ No <br /> Additional information or comments: <br /> 3. GARBAGE & REFUSE: <br /> Licensed scavenger pick-up? 0 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: njj,4 <br /> S. TOILET/BATH FACILITIES: <br /> Number and Location(s)of existing facilities: ItL4 <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> 7. GENERAL SANITATION: <br /> List any problem(s) not previously noted: -4�f <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> iH 06 Ob Report#7201 October 03.200? <br />