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e <br /> NOTE: PULL A RMITS (Septic, Well, etc.) M i PIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: 4a' Connection Necessary? 19 Yes E] No <br /> Does Existing Septic System comply with San Joaquin County Development Title? Yes E] No Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> i <br /> s <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well? F1 Yes No Is well properly sealed and constructed ? Yes ❑ 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 ? F-� Yes E] 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? � Yes ❑ No Service Area No. <br /> k Other proposed disposal method: <br /> Potential Problem(s)- <br /> 4. FLY MOSQUITO OR VECTOR CONTROL: <br /> Describe potential Vector Control issues: <br /> e <br /> 5. TOILET 1 BATH FACILITIES: <br /> f <br /> Number and Location(s)of existing facilities: /(�i4" It <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> 7. GENERAL SANITATION: <br /> List any problem(s) not previously noted <br /> F <br /> r <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> r <br /> £H 06 06 Report#7201. Page 2 June 21,2004 <br /> r <br />