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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...)'IGIAKE COPIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: )fJ Connection necessary: Yes No <br /> Does existing septic system comply with San Joaquin County Development Title X549 '? <br /> Yes No Unknown If no. explain: <br /> Describe septic installation to be installed: <br /> 2. WATER SUPPLY: <br /> Is water supplied by private well: Yes No Is well proper: YesNo <br /> State deficiency: <br /> Is well system a Public Water system? Yes No Y Is the permit current? Yes No <br /> Does existing or proposed use make this well Public Water: Yes No Is water/well <br /> sampling current: yes No Additional information or comments: <br /> 3. GARBAGE & REFUSE: <br /> Licensed scavenger pick-up: Yes No _ Service Area No.: Other proposed <br /> disposal method: <br /> Potential problem(s): <br /> 4. FLY, MOSQUITO OR VECTOR POTENTIAL: <br /> State possible vector potential and necessary control: 1)0"4-- <br /> 5. TOILETBATH FACILITIES: <br /> Number and locations existing: _ /.E.tc'r t '� S%5?��*r.� Additional <br /> facilities needed: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> 7. GENERAL SANITATION: <br /> State any problems not previous]y noted: 4,,k o K <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> Eh(06 06 Rev 1/99 <br />