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NOTE: PULL. AL 'ERMITS (Septic, Well, etc.) MAK�,40PIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: Q Connection Necessary ? ❑ Yes No <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 ? 0 Y-es ❑ No Is well properly sealed and constructed ? EI-'Yes F] No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? ❑ Yes �'No . Is Public Water System Permit current? : Yes No <br /> Does existing or proposed use male this a Public Water System ? ❑ Yes No <br /> Is water/well sampling current? 0 Yes F No <br /> Additional information or comments: <br /> 3. GARBAGE&REFUSE: - <br /> Licensed scavenger pick-up? /ryes [-] No Service Area No. <br /> Other proposed disposal method.- <br /> Potential <br /> ethod:Potential Problem(s): <br /> 4. FLY MOSQUITO OR VECTOR CONTROL: <br /> Describe potential Vector Control issues: <br /> S. 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: <br /> Approximate number of people per square mile: <br /> EH 06 06 Report 47201 December 29,2009 <br />