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NOTE: PULL ALL IRMITS (Septic, Well, etc.) MAKE )PIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: Connection Necessary ? r_1 Yes No <br /> Does Existing Septic System comply with San Joaquin County Development Title ? © Yes F-1 No F_� Unkno%�n <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? F-1 Yes arNo Is well properly sealed and constructed ? Yes No <br /> Describe deficiency, if any: <br /> Is well system a Public Water system ? 7 Yes [__1 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 F_� No <br /> Additional information or comments: <br /> 3. GARBAGE& REFUSE: <br /> Licensed scavenger pick-up? d Yes 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: �(l <br /> 5. TOILET/ BATH FACILITIES: <br /> Number and Location(s)of existing facilities: jZG,/{,71,a9L��G�{(,( ,rf/�j.=jam Qr�t/ji,�jam• <br /> Additional facilities required: E <br /> 6. PREVIOUS OPERATION HISTORY: <br /> r1�urZuf <br /> 7. GENERAL SANITATION: <br /> List any problem(s) not previously noted: 4- <br /> S. POPULATION DENSITY: <br /> Approximate number of people per square mile: �Gyipy)��JZ4 �i2/719'1'�Lt4v <br /> EH 06 06 Repon#7201 December off. '0a' <br />