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NOTE: PULL ALL RMITS (Septic, Well, etc.) MAKE .. PIES FOR FILE <br /> I. SEWAGE: <br /> Distance.to Public Sewers:_zc/A Connection Necessary? 0 Yes Z No <br /> Does Existing Septic System comply with San Joaquin County Development Title? EKYes F1 No Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: i <br /> I <br /> i <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? E2ryes Ej No Is well properly sealed and constructed ? Yes ❑ No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? ❑ Yes Ea No Is Public Water System Permit current? Yes F-1 No <br /> Does existing or proposed use make this a Public Water System ? 0 Yes allo <br /> Is water/well sampling current? F-� Yes No <br /> Additional information or comments: <br /> 3. GARBAGE&REFUSE: <br /> Licensed scavenger pick-up? Ez Yes No Service Area No. : ' <br /> Other proposed disposal method: <br /> Potential Problem(s).- <br /> 4. <br /> roblem(s):4. FLY MOSQUITO OR VECTOR CONTROL: <br /> Describe potential Vector Control issues: —14/ <br /> I <br /> I <br /> 5. TOILET 1 BATH FACILITIES: i <br /> Number and Location(s)of existing facilities: <br /> Additional facilities required: ! <br /> 6. PREVIOUS OPERATION HISTORY: <br /> I <br /> i <br /> — j <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 /> { <br /> H 06 06 Report#7201 May 18,2007 <br />