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1 <br /> NOTE: PULL AL . ERMITS (Septic, Well, etc.) MAKPEOPIES FOR FILE ' <br /> 1. SEWAGE: <br /> Distance to Public Sewers: , 50 Connection Necessary? Yes No <br /> Does Existing Septic System comply with San Joaquin County Development Title? ❑ Yes ❑ No ❑ Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private.Well? F-j Yes Ej No Is well properly sealed and constructed ? ❑ Yes F] No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system? ❑ Yes ❑ No Is Public Water System Permit current? ❑ Yes Ej No <br /> Does existing or proposed use make this a Public Water System? F-] Yes ❑ No <br /> Is water/well sampling current? F-j Yes F-] No <br /> Additional information or comments: <br /> 3. GARBAGE&REFUSE: <br /> Licensed scavenger pick-up? ❑ Yes dNo Service Area No.: <br /> Other proposed disposal method: - 2 &7 p <br /> Potential Problem(s): <br /> 4. FLY,MOSQUITO OR VECTOR CONTROL: <br /> Describe potential Vector Control issues: >� � /1lyy i5 P�"�!3i dlLc T� Sa��� <br /> 5. TOILET/BATH FACILITIES: <br /> Number and Location(s)of existing facilities: <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> c, Ts>u e"yJ(E�I;C <br /> 7. GENERAL SANITATION: <br /> List any problem(s)not previously noted <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: ) C14/�v / � �,���mac,, /�,. <br /> EH 06 06 Report#7201 Page 2 April 16,2004 <br />