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t <br /> L. <br /> NOTE: PULL ALL RMITS (Septic, Well, etc.) MAKE aP1ES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers; Connection Necessary? ❑ Yes EDINO <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 /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? !�Yes No Is well properly sealed and constructed ? �es NO <br /> Describe deficiency,if any: <br /> Is well system n Public Water system . E] Yes fff No Is Public Water System Permit current . Yes NO <br /> Does existing or proposed use make this a Public Water System ? F1 Yes ❑ No <br /> Is water/well sampling current? ❑ Yes ❑ No <br /> Additional information or comments: i <br /> 3. GARBAGE&REFUSE: <br /> Licensed scavenger pick-up?. ❑ Yes �No Service Area No. : <br /> Other proposed disposal method: 1 <br /> Potential Problem(s): <br /> i <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 /> List any problem(s) not previously noted: <br /> S. POPULATION DENSITY: �I <br /> Approximate number of people per square mile: <br /> M 06 06 Report 97201 August 24,.2067 <br />