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NOTE: PULL AERMITS (Septic, Well, etc.) MAKOPIES FOR FILE r <br /> 1. SEWAGE: <br /> Distance to Public Sewers: Connection Necessary? D Yes -EI—No <br /> Does Existing Septic System comply with San Joaquin County Development Title? Yes No Unknown <br /> -If no,explain: % <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well? ,E]Yes ❑ No Is well properly sealed and constructed ? P-1 Yes ❑ No <br /> Describe deficiency, if any: <br /> Is well system a Public Water system ? Yes AEf No Is Public Water System Permit current? ❑ Yes No <br /> Does existing or proposed use make this a Public Water System ? F-1 Yes ❑ No <br /> Is water/well sampling current ? ❑ Yes ❑ No <br /> Additional information or comments: <br /> 3. GARBAGE&REFUSE: <br /> Licensed scavenger pick-up? ❑ Yes eNo 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 /> 7 <br /> - <br /> 5. TOILET 1 BATH FACILITIES: <br /> Number and Location(s)of existing facilities: ,,�� <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> ol <br /> 7. GENERAL SANITATION: <br /> List any problem(s)not previously noted: / y <br /> S. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> I <br /> EH 06 06 Report#7201 <br /> October 17,2005 .� <br />