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NOTE. PULL ALW. RMITS (Septic, Well, etc.) MAKE PIES FOR FILE <br /> 1. SEWAGE: _ <br /> Distance to Public Sewers: Connection Necessary ? ❑ Yes ❑ No <br /> Does Existing Septic System comply with San Joaquin County Development Title? 0 Yes ❑ No Ej Unknown <br /> If no, explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? Yes ❑ No Is well properly sealed and constructed? Yes ❑ No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? F-1 Yes ❑ No Is Public Water System Permit current? Yes F-1 No <br /> Does existing or proposed use make this a Public Water System ? 7 Yes No <br /> Is water I well sampling current ? F-1 Yes F-1 No <br /> Additional information or comments: <br /> 3. GARBAGE&REFUSE: <br /> Licensed scavenger pick-up? ❑ Yes ❑ 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 /> 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 /> rl 106 06 Report 97201 January OS,2009 <br />