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a ! <br /> NOTE: PULL AQ ERMITS (Septic, Well, etc.) MAK.., ;OP1ES FOR FILE <br /> 1. SEWAGE: <br /> 1 <br /> Distance to Public Sewers: 7,�J Connection Necessary? 0 Yes �No <br /> Does Existing Septic System comply with San Joaquin County Development Title? Yes No O/Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well? 0 Yes No Is well properly scaled and constructed? F] Yes ❑ No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? Yes No Is Public Water System Permit current? F-1 Yes ❑ No <br /> Does existing or proposed use make this a Public Water System ? ❑ Yes No <br /> Is water/well sampling current? ❑ Yes [:] No <br /> Additional information or comments: <br /> 3. GARBAGE&REFUSE: <br /> Licensed scavenger pick-up? Yes F� 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 1 BATH FACILITIES: <br /> Number and Location(s)of existing facilities: - <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: <br /> EH 06 06 Report 47201 October 27,2005 <br />