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r*q <br /> NOTE: PULL ALtpc'RMITS (Septic, Well, etc.) MAK"JP1ES FOR FILE Y ' <br /> 1. SEWAGE: <br /> Distance to Public Sewers: -��C 3' Connection Necessary? [:] Yes ,T No <br /> Does Existing Septic System comply with San Joaquin County Development Title ? Yes No Fe,71 Unknown <br /> If no,explain: <br /> i <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: �`1/ <br /> Is Water supplied by Private Well ? �s F-] No Is well properly sealed and constructed?�P--r Yes [:] No <br /> Describe deficiency,if any: 02�- � <br /> Is well system a Public Water system ? ❑ Yes No Is Public Water System Permit current? Yes No <br /> Does existing or proposed use make this a Public Water System ? E] Yes ❑ No <br /> Is water/well sampling current? F—] Yes ❑ No <br /> Additional information or comments: <br /> 3. GARBAGE&REFUSE: <br /> Licensed scavenger pick-up? ET Yes 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 /> S. TOILET/BATH FACILITIES: <br /> Number and Location(s)of existing facilities: <br /> Additional facilities required: <br /> h• 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 /> EH 06 06 Report#7201 July 17,2009 <br />