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NOTE: PULL AL 'ERMITS (Septic, Well, etc.) MAK _:OPIES FOR FILE <br /> I. SEWAGE: <br /> Distance to Public Sewers: L Connection Necessary ? M' Yes F—] No <br /> Does Existing Septic System comply with San Joaquin County Development Title ? D Yes El Nc FT L ug <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? [:] Yes F No Is well properly sealed and constructed ? Fj Yes F—] No <br /> Describe deficiency, if any: <br /> Is well system a Public Water system ? F_� Yes F—] No Is Public Water System Permit current ? F-1 Yes F_� No <br /> Does existing or proposed use make this a Public Water System ? F—] Yes F_� 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? 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 /> 7. GENERAL SANITATION: <br /> List any problem(s) not previously noted: <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: G,cr/j� Zt1yZ�r�lf� <br /> EH 06 06 Report#7201 March 19,2003 <br />