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NOTE: PULL ALL __RMITS (Septic, Well, etc.) MAKE _:PIES FOR FILE <br /> I. SEWAGE: `/ <br /> Distance to Public Sewers: Z4 Connection Necessary? ❑ Yes [?"'No <br /> Does Existing Septic System comply with San Joaquin County Development Title ? Ej Yes ❑ No E] Unknown <br /> no,explain: <br /> scribe Septic System to be installed: <br /> A R SUPPLY: <br /> Is Water supplied by Private Well ? d Yes ❑ No Is well properly sealed and constructed ? Yes No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? Yes ❑ No Is Public Water System Permit current? Yes No <br /> Does existing or proposed use make this a Public Water System? 0 Yes No <br /> Is water/well sampling current ? ❑ Yes No <br /> Additional information or comments: <br /> 3. GARBAGE R REFUSE: <br /> Licensed scavenger pick-up? dYes F� No Service Area No. : <br /> Other proposed disposal method: <br /> otential Problem(s): <br /> FLY, MOSOUITO OR VECTOR CONTROL,: /` <br /> Describe potential Vector Control issues: A)A <br /> TOILET/BATH FACILITIES: <br /> Number and Location(s)of existing facilities: <br /> Additional facilities required: <br /> • PREVIOUS OPERATION HISTORY: <br /> 7. GENERAL SANITATION: <br /> List any problem(s)not previously noted: NAA- <br /> POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> rt 97201 N1urh 0'.ZOOv <br />