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NOTE: PULL_ 1. PERMITS (Septic, Well, etc.) N. :E COPIES FOR FILE <br /> L SEWAGE: <br /> Distance to Public Sewers: Connection Necessary ? Yes No <br /> Does Existing Septic System comply wth San Joaquin County Development Title ? ❑ Yes F-1 No Unknown <br /> If no, explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? [Z Yes 0 No Is well properly sealed and constructed ? Q Yes F_� No <br /> Describe deficiency, if any: <br /> Is well system a Public Water system ? F� Yes 2 No Is Public Water System Permit current ? ❑ Yes ❑ No <br /> Does existing or proposed use make this a Public Water System ? ❑ Yes F;� No <br /> Is water/well sampling current ? El Yes F-1 No <br /> Additional information or comments: <br /> 3. GARBAGE& REFUSE: <br /> Licensed scavenger pick-up? F—] Yes F__j No Service Area No. <br /> Other proposed disposal method: <br /> Potential Problem(s): <br /> 4. FLY, MOSQUITO OR VECTOR COI%'TROL: <br /> Describe potential Vector Control issues: _ 1411-4 <br /> 5. TOILET/ BATH FACILITIES: <br /> Number and Location(s) of existing facilities: x,jy./e C) -%2CS/DcE a✓ /1STitW'tn77�1__ <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> .CIES.✓ / <br /> 7. GEN ERALSANITATION: <br /> List any problem(s) not previously noted 4A <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> EH 06 06 Repon#7201 Page 2 June 'I 'N14 <br />