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NOTE: PULL ALLti ERMITS (Septic, Well, etc.) MAKE _4PIE3 FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: Z°0 1`f - Connection Necessary ? Yes No <br /> Does Existing Septic System comply with San Joaquin County Development Title? F-1Yes ©No F-1Unknown <br /> If no,explain: /u"'ri ' s o. S ,(.e <br /> Describe Septic System to be installed: A,11A <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? F] Yes E r4Aciency, <br /> Is well properly sealed and constructed ? Yes � No <br /> Describe defiif any: H� <br /> Is well system a Public Water system ? ❑ Yes EDNo Is Public Water System Permit current? Yes ❑ No <br /> Does existing or proposed use make this a Public Water System ? F-1 Yes Deo <br /> Is water/well sampling current ? F-1 Yes F-1 No <br /> Additional information or comments: 1 ,1 I, a 4,ja14t — <br /> 3. GARBAGE& REFUSE: <br /> Licensed scavenger pick-up? Yes F-1 No Service Area No. <br /> Other proposed disposal method: <br /> Potential Problem(s): /J I <br /> 4. FLY MOSQUITO OR VECTOR CONTROL: <br /> Describe potential Vector Control issues: nJ <br /> 5. TOILET/ BATH FACILITIES: <br /> Number and Location(s)of existing facilities: _C7� S 1=r�" <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> C, ;e � I <br /> 7. GENERAL SANITATION: <br /> List any problem(s) not previously noted h' / <br /> S. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> EH 06 06 Report 47201 Page 2 June 21,2004 <br />