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NOTE: PULL H ERMITS (Septic, Well, etc.) MAK640PIES FOR FILE T <br /> 1. SEWAGE: <br /> Distance to Public Sewers: Connection Necessary? u Yes No <br /> Does Existing Septic System comply with San Joaquin County Development Title? [3,Yes F� No ❑ Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? ED Y s ED No Is well properly sealed and constructed ? H'Yes F_� No <br /> Describe deficiency, if any: <br /> Is well system a Public Water system ? [:] Yes 2No Is Public Water System Permit current? F� Yes F-1 No <br /> Does existing or proposed use make this a Public Water System? ❑ Yes ❑ No <br /> Is water/well sampling current? ❑ Yes [:] 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: k <br /> I <br /> Potential Problem(s): <br /> 4. FLY MOSQUITO OR VECTOR CONTROL: <br /> Describe potential Vector Control issues: <br /> 5. TOILET I BATH FACILITIES: <br /> Number and Location(s)of existing facilities: <br /> Additional facilities required: <br /> 6. .PREVIOUS OPERATION HISTORY: <br /> I, <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 06 06 Report 47201 <br /> May 25,2010 <br />