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NOTE: PULL Aft,.'ERMITS (Septic, Well, etc.) MAkkr&PIES FOR FILE " <br /> 1. SEWAGE: <br /> Distance to Public Sewers::: Connection Necessary I Yes J2, 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? Yes � No Is well properly sealed and constructed?,rYes No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? ❑ Yes EKo Is Public Water System Permit current? Yes No <br /> Does existing or proposed use make this a Public Water System ? Yes El No <br /> Is water/well sampling current? n Yes n No <br /> Additional information or comments: <br /> 3. GARBAGE&REFUSE: <br /> Licensed scavenger pick up? Yes ❑ 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/BATH FACILITIES: <br /> Number and Location(s)of existing facilities: <br /> Additional facilities required: <br /> G. 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: •�CZ J ��, , <br /> i <br /> EH 06 06 Report 97201 June 15,2005 <br /> 1 <br />