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NOTE: PULL AL!�,ERMITS (Septic, Well, etc.) MAKE PIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: Id Connection Necessary? Q' Yes No <br /> Does Existing Septic System comply with San Joaquin County Development Title? Yes No U4 .H49WH <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? E] Yes []a No Is well properly sealed and constructed ? Yes [7 No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? Ej Yes ❑ No Is Public Water System Permit current? Yes ❑ No <br /> Does existing or proposed use make this a Public Water System? ❑ Yes [2r No <br /> Is water 1 well sampling current? ❑ Yes ❑ No <br /> Additional information or comments: <br /> 3. GARBAGE& REFUSE: <br /> Licensed scavenger pick-up? [Z 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: _�ll� <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 <br /> S. POPULATION DENSITY: <br /> Approximate number of people per square mile: e-.n5'j- <n::2 t� <br /> EH 06 06 Report#7201 Page 2 June 21,2004 <br />