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NOTE: PULL ALl cRMITS (Septic, Well, etc.) MAKI .-DPIES FOR FILE <br /> 1. SEWAGE: 11 <br /> Distance to Public Sewers: Connection Necessary ? ❑ Yes F�j No <br /> Does Existing Septic System comply with San Joaquin County Development Title? Yes F-1 No F� Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? M Yes F-1 No Is well properly sealed and constructed ? 0 Yes Ej No <br /> Describe deficiency, if any: <br /> Is well system a Public Water system ? ❑ Yes E2"No Is Public Water System Permit current? Yes No <br /> Does existing or proposed use make this a Public Water System ? F] Yes 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? F-1 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: <br /> 5. TOILET/BATH FACILITIES: <br /> Number and Location(s)of existing facilities: /J1GfL� f�fsll '1(Pl3/S / O�7tC <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 /> I1 06 06 Report 47201 July 25,2008 <br />