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NOTE: PULL ALL---ERMITS (Septic, Well, etc.) MAKE sOP1ES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: / Connection Necessary ? ❑ Yes Q No <br /> Does Existin>;Seotic System comply with San Joaquin County Development Title ? Q Yes E) No ❑ Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: L 4-i �n e S�Js� ova re A6-d <br /> IN` 1zi)o ; .t >�E d Pyle /oe) ' le&.L, J,he Pyf 41_0 <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well? ❑ Yes Q No Is well properly sealed and constructed ? 0 Yes [] No <br /> Describe deficiency,if any: -�/e '4/L 44,01^4 4 i✓dG'r9 on ::wrec Q Z7,01 Dooms <br /> ,lea sa. eQ b <br /> �� l aol shown a✓I �t.� vfa <br /> Is well system a Pub ' ater system? El Yes E] No Is Public Water System Permit current? Yes F-1 No <br /> Does existing or proposed use make this a Public Water System? F-1 Yes 0 No <br /> Is water/well sampling current? F-1 Yes F-1 No <br /> Additional information or comments: <br /> 3. GARBAGE&REFUSE: <br /> Licensed scavenger pick-up? F� 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: ob�e✓JQd <br /> 5. 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 /> EH 06 06 Repan#7201 January 18,2006 <br />