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NOTE: PULL ALV . ..RMITS (Septic, Well, etc.) MAKE+..;tP1ES FOR FILE <br /> VW- <br /> I. SEWAGE: <br /> Distance to Public Sewers: Connection Necessary? E Yes E] No <br /> j with San Joaquin County Development Title? Yes No Unknown <br /> Does Existing Septic System comply <br /> If no, explain: <br /> Describe Septic System to be installed: <br /> i <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well? Yes 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? Yes No <br /> Does existing or proposed use make this a Public Water System ? ❑ Yes No <br /> ! <br /> Is water/well sampling current? F� Yes ❑ No <br /> Additional information or comments: <br /> e <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 MOS UITO OR VECTOR CONTROL: <br /> Describe potential Vector Control issues: <br /> 5. TOILET 1 BATH FACILITIES: <br /> Number and Location(s)of existing facilities: <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> E <br /> 7. GENERAL SANITATION: <br /> List any problem(s)not previously noted: <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> 3 <br /> f <br /> i <br /> Eli 06 06 Report 47201 October 13,2008 <br />