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NOTE: <br /> PULL ALL IRMITS (Septic, Well, etc.) MAK )PIES FOR FILE r <br /> 1. SEWAGE: <br /> Distance to Public Sewers: Connection Necessary? F-1 Yes F_� 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? YesNo Is well properly sealed and construct Yet No <br /> Describe deficiency,if any: �� n���� cry {�✓�� <br /> _ r- <br /> Is well system a Public 4ater system ? ❑ Yes yj No Is Public Water System Permit current? Yes ❑ No <br /> Does existing or proposed use make this a Public Water System ? ❑ Yes F-1 No <br /> Is water/well sampling current? ❑ Yes F-1 No <br /> Additional information or comments: <br /> 3. GARBAGE& REFUSE: <br /> Licensed scavenger pick-up? F-1 Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential Problem(s): 22 <br /> 4. FLY,MOSQUITO OR VECTOR CONTROL: <br /> Describe potential Vector Control issues: Z2ma4 c e=aL <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 /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: v0 <br /> EH 06 06 Repon 47201 Page 2 June 21,2004 <br />