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NOTE: PULL AL ERMITS (Septic, Well, etc.) MAK. OPIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: Connection Necessary ? ❑ Yes P7] No <br /> Does Existing Septic System comply with San Joaquin County Development Title? Y'es F-] No F,-] Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. NATER SUPPLY: <br /> Is Water supplied by Private Well ? [21-Yes ❑ No Is well properly sealed and constructed ? 0 Yes No <br /> Describe deficiency, if any: <br /> Is well system a Public Water system ? F-1 Yes E] No Is Public Water System Permit current ? F� Yes No <br /> Does existing or proposed use make this a Public Water System ? F-1 Yes F� No <br /> Is water/well sampling current? F� Yes F-1 No <br /> Additional information or comments: <br /> 3• GARBAGE& REFUSE: <br /> Licensed scavenger pick-up? ® Yes F-] 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: <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: / z <br /> 8. POPULA'T'ION DENSITY: <br /> Approximate number of people per square mile: <br /> i:H 06 06 Revd e7lo I <br />