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e t i <br /> NOTE: PULL AL RMITS (Septic, Well, etc.) MAK PIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: /' r''� Connection Necessary ? F—] Yes No <br /> Does Existing Septic System comply with San Joaquin County Development Title? Yes No Q Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? 0 Yes No Is well properly sealed and constructed ?,E] Yes F-1 No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? 0 Yes F/71—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/well sampling current? El Yes � No <br /> Additional information or comments: �7 <br /> 3. GARBAGE& REFUSE: <br /> Licensed scavenger pick-up? �es F-] 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 /> 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: <br /> H 06 06 Report 47201 October 27,2005 <br />