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NOTE: PULL ALL RMITS (Septic, Well, etc.) MAKE /PIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: A(1/14 Connection Necessary? F] Yes a&o N <br /> Does Existing Septic System comply with San Joaquin County Development Title? ❑ Yes ❑ No EDUnkn Wn <br /> If no,explain: <br /> Describe Septic System to be installed: 1�eeff5 /Z19- <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? Dyes F-] No Is well properly sealed and constructed ? Yes No <br /> Describe deficiency,if any: r/ �5 <br /> Is well system a Public Water system ? ❑ Yes ERNo Is Public Water System Permit current? Yes No <br /> Does existing or proposed use make this a Public Water System ? ❑ Yes ❑V No <br /> Is water/well sampling current? ❑ Yes ❑ No <br /> Additional information or comments: <br /> 3. GARBAGE& REFUSE: <br /> Licensed scavenger pick-up? ❑ Yes ErNo 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: jc/��/�LD �C �C �lcliwJ��g-cel` �c <br /> 5. TOILET/ BATH FACILITIES: <br /> Number and Location(s)of existing facilities: ,(//1 <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 /> EH O6 06 Report#7201 Page 1 June 01,2004 <br />