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^ NOTE: PULL ALL iRMITS (Septic, Well, etc.) MAKE )PIES FOR FILE <br /> I. SEWAGE: <br /> Distance to Public Sewers: Connection Necessary ? ❑ Yes No <br /> Does Existing Septic System comply with San Joaquin County Development Title? Yes ❑ No Unknown <br /> If no, explain: <br /> Describe Septic System to be installed: <br /> F <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? ❑ Yes 7 No Is well properly sealed and constructed ? ❑ Yes No <br /> Describe deficiency, if any: <br /> Is well system a Public Water system? ❑ 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 1 well sampling current? ❑ Yes R 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 /> i Describe potential Vector Control issues: <br /> 5. TOILET I BATH.FACILITIES: <br />' Number and Location(s)of existing facilities: <br /> i Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> 4 <br /> N <br /> 7. GENERAL SANITATION: <br /> List any problem(s) not previously noted: <br /> �E <br /> f <br /> ' 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> E <br /> 1;H 06 06 Report#7201 December 24,2008 <br /> M <br /> Ii <br /> k <br />