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f- . <br /> NOTE: PULL AERMITS (Septic, Well, etc.) MAIOPIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: l Connection Necessary? ❑ Yes No <br /> Does Existing Septic System comply with San Joaquin County Development Title? Yes No Ej Unlm4wn <br /> E� <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well? F-1 Yes EZ"No Is well properly sealed and constructed? ❑ Yes E] No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? ❑ Yes F 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? F-1 Yes F-1 No <br /> Additional information or comments: <br /> 3. GARBAGE&REFUSE: <br /> Licensed scavenger pick-up? IrYes F-1 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 /> i <br /> Gl /� <br /> 7. GENERAL SANITATION: <br /> List any problem(s)not previously noted: <br /> 8. POPULATION DENSITY: <br /> e <br /> Approximate number of people per square mile: — <br /> E1-106 06 Report#7201 December 01,2005 <br /> iH <br />