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� t <br /> . a <br /> NOTE: PULL ALL !RMITS (Septic, Well, etc.) MAKE PIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: AJ Connection Necessary? F-1 Yes ENo <br /> Does Existing Septic System comply with San Joaquin County Development Title? 0 Yes Q'No Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: 6'eAtt LIVLe�ueA� ; y S ti Cl 1-s <br /> u,Q aA,, veSCc IfS 04' 011iaJ-e- to za S oe <br /> 2. WATER SUPPLY: [6- i���✓ <br /> Is Water supplied by Private Well? Yes No Is well properly sealed and constructed? Yes No <br /> Describe deficiency,if any: <br /> L��.L�C cit2✓.ti C'_G4,S'f-uc74Tca_ <br /> Is well system a Public Water system ? F-1 Yes [TNo Is Public Water System Permit current? Yes E3—No <br /> Does existing or proposed use make this a Public Water System ? Yes No <br /> Is water/well sampling current? F] Yes E3--No <br /> Additional information or comments: <br /> 3. GARBAGE& REFUSE: <br /> Licensed scavenger pick-up? F-1 Yes E N Service Area No. <br /> Other proposed disposal method: <br /> Potential Problem(s): <br /> 4. FLY,MOSOUITO OR VECTOR CONTROL: <br /> Describe potential Vector Control issues: /U a <br /> 5. TOILET/BATH FACILITIES: <br /> Number and Location(s)of existing facilities: <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> /�-I �" c.-,„ c+'" <br /> 7. GENERAL SANITATION: f <br /> List any problem(s)not previously noted / t4 <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> EH 06 06 Report#7201 Page 2 June 21,2004 <br />