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NOTE: PULL ALL :RMITS (Septic, Well, etc.) MAKE JPIES FOR FILE <br /> 1. SEWAGE: r <br /> Distance to Public Sewers: /[x:' Connection Necessary ? F-] Yes [��Y'.No <br /> Does Existing Septic System comply with San Joaquin County Development Title ? Yes F-] No F� l44h l n <br /> If no, explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? E Yes [:�r No Is well properly sealed and constructed Yes [:] No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? F—] Yes F-] No Is Public Water System Permit current ? El Yes El No <br /> Does existing or proposed use make this a Public Water System? F-1 Yes F-] No <br /> Is water/well sampling current? F-1 Yes I--] No <br /> Additional information or comments: <br /> 3. GARBAGE& REFUSE: <br /> Licensed scavenger pick-up? F-1 Yes © o 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 /> 7. GENERAL SANITATION: <br /> List any problem(s) not previously noted: " <br /> S. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> E <br /> '-H 06 06 Report 0201 Ortr,bei u,� <br />