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NOTE: PULL ALI RMITS (Septic, Well, etc.) MAKE PIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers:��– Connection Necessary ? Yes No <br /> Does Existing Septic System comply with San Joaquin County Development Title ? Yes No [2y Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? ErYes 0 No Is well properly sealed and constructed ? Yes No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? [:] Yes ER"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 ? 0 Yes ❑ No <br /> Additional information or comments: <br /> 3. GARBAGE & REFUSE: <br /> Licensed scavenger pick-up? ❑ Yes F11 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: ��4 <br /> 5. TOILET/ BATH FACILITIES: <br /> Number and Location(s)of existing facilities: /�e �_ �L17�–�•jj <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: z��J—r– o(2. y(6 <br /> EH 06 06 Report#7201 Pape 2 June 21.2004 <br />