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1 <br /> NOTE: PULL ALL 2MITS (Septic, Well, etc.) MAKE PIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: /t//,+ Connection Necessary? 0 Yes allo <br /> Does Existing Septic System comply with San Joaquin County Development Title? EfYes 0 No 0 Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? EO/Yes E] No Is well properly sealed and constructed ? Yes D No <br /> Describe deficiency, if any: <br /> Is well system a Public Water system ? 0 Yes No Is Public Water System Permit current? Yes E] No <br /> E } <br /> Does existing or proposed use make this a Public Water System ? M Yes 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? V 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 /> & <br /> 7. GENERAL SANITATION: <br /> List any problem(s) not previously noted: <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: J '�✓ . <br />::H 06 06 Report 47201 July 07,2., , <br />