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NOTE: PULL AL ERMITS (Septic,Well, etc.) MAKL,.OPIES FOR FILE { <br /> I. SEWAGE: <br /> Distance to Public Sewers: i �� �_ Connection Necessary ? F-1 Yes �No <br /> Does Existing Septic System comply with San Joaquin County Development Title? 0Yes F-� No E] Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well? Yes ❑ No Is well properly sealed and constructed ? ®'Yes 0 No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system? E"Nes ❑ No Is Public Water System Permit current? fff Yes ❑ No <br /> Does existing or proposed use make this a Public Water System ? Yes No <br /> Is water 1 well sampling current? El Yes No <br /> Additional information or comments: <br /> 3. GARBAGE& REFUSE: <br /> Licensed scavenger pickup? 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 /> r f <br /> List any problem(s) not previously noted: <br /> S. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> EH 06 06 Report 47201 Novernbet 03,2009 <br />