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NOTE: PULL ALI- _ RMITS (Septic, Well, etc.) MAKFf f <br /> aP1ES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: c'jtf� Connection Necessary ? Yes No <br /> Does Existing Septic System comply with San Joaquin County Development Title ? yes No <br /> El Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? LSC' No Is well properly sealed and constructed ? es ❑ No <br /> Describe deficiency, if any: <br /> Is well system a Public Water system ? El Yes No Is Public Water System Permit current? ❑ Yes No <br /> Does existing or proposed use make this a Public Water System ? r-1 Yes No <br /> Is water/well sampling current ? D Yes ❑ No <br /> Additional information or comments: <br /> t <br /> 3. GARBAGE& REFUSE: <br /> Licensed scaven er <br /> g pick-tip? es No Service Area No. <br /> Other proposed disposal method: <br /> Potential Problem(s): r <br /> 4. FLY MOSQUITO OR VECTOR CONTROL: <br /> Describe potential Vector Control issues: <br /> S. TOILET/BATH FACILITIES: f <br /> Number and Location(s) of existing facilities: <br /> Additional facilities required: <br /> E <br /> 6. PREVIOUS OPERATION HISTORY: <br /> 7. GENERAL SANITATION: <br /> List any problem(s) not previously noted: { <br /> S. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> E <br />:H 06 06 Report 47201 March 31,2008 <br />