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NOTE: PULL, ALL tWITS (Septic, Well, etc.) MAKE G` IES FOR FILE <br /> 1. SEWAGE: /J <br /> Distance to Public Sewers:___ ,U�/, Connection Necessary ? 0 Yes No <br /> Does Existing Septic System comply with San Joaquin County Development Title ? Yes ❑ No F�_/f Wnknbvm <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? ❑ Yes [E�No Is well properly scaled and constructed ? Yes No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? F] Yes 7 No Is Public Water System Permit current ? Yes 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? E] 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: ,, /— <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: iv <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: 6 1/� , —(/ <br /> 106 06 Report#7201 May 16,2005 <br />