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NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br />1. SEWAGE: <br />Distance to Public Sewers: Connection Necessary ? F-1 Yes F-] No <br />Does Existing Septic System comply with San Joaquin County Development Title ? E] Yes F-1 No Unknown <br />If no, explain: <br />Describe Septic System to be installed: <br />EH 06 06 Report 47201 March 23, 2017 <br />2. WATER SUPPLY: <br />Is Water supplied by Private Well ? E] Yes F] No <br />Describe deficiency, if any: <br />Is well properly sealed and constructed ? Yes No <br />Is well system a Public Water system ? F] Yes F] No Is Public Water System Permit current ? Yes No <br />Does existing or proposed use make this a Public Water System ? F� Yes F_� No <br />Is water / well sampling current ? F-] Yes F-1 No <br />Additional information or comments: <br />3. GARBAGE & REFUSE: <br />Licensed scavenger pick-up? F-1 Yes F-] No <br />Other proposed disposal method: <br />Potential Problem(s): <br />Service Area No.: <br />4. FLY, MOSOUITO OR VECTOR CONTROL: <br />Describe potential Vector Control issues: <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 />8. POPULATION DENSITY: <br />Approximate number of people per square mile: <br />EH 06 06 Report 47201 March 23, 2017 <br />