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NOTE: PULL ALL �RMITS (Septic, Well, etc.) MAKE CIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: '7G1'- Connection Necessary ? ❑ Yes E3—No <br /> Does Existing Septic System comply with San Joaquin County Development Title? ❑ Yes ❑ No Er Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? ❑ 'ices ❑ No Is well properly sealed and constructed ? -ewes ❑ No <br /> Describe deficiency, if any: <br /> Is well system a Public Water system ? Yes Er No Is Public Water System Permit current? Yes No <br /> Does existing or proposed use make this a Public Water System ? ❑ Yes ❑ No <br /> Is water 1 well sampling current? ❑ Yes ❑ No <br /> f <br /> Additional information or comments: <br /> 3. GARBAGE&REFUSE: <br /> Licensed scavenger pick-up? P�:::�es ❑ No Service Area No. <br /> Other proposed disposal method: <br /> Potential Problem(s): <br /> 4. FLY, MOSQUITO OR VECTOR CONTROL: E <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 /> S. POPULATION DENSITY: <br /> Approximate number of people per square mile <br /> Al 06 06 Report 47201 December 26,2007 <br />