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NOTE: PULL ALL f,. :MITS (Septic, Well, etc.) MAKE ( +IES FOR FILE <br /> 1. SEWAGE: �-�y <br /> Distance to Public Sewers: Connection Necessary? Yes u No <br /> Does Existing Septic System comply with San Joaquin County Development Title? ❑ Yes E] No Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? Yes ❑ No Is well properly sealed and constructed ? Ez' Yes E3""No <br /> Describe deficiency,if any: f—L)(- 4 LS f�Cl�lt�� <br /> Is well system a Public Water system ? ❑ Yes E:O/No Is Public Water System Permit current? Ej Yes 0 No <br /> Does existing or proposed use make this a Public Water System ? F-1 Yes 1� No <br /> Is water 1 well sampling current? ❑ Yes F-] No <br /> Additional information or comments: <br /> 3. GARBAGE &REFUSE: <br /> Licensed scavenger pick-up? ❑ Yes F-1 No Service Area No. : <br /> Other proposed disposal method: <br /> Potential Problem(s): <br /> 4. FLY MOS UITO OR VECTOR CONTROL: <br /> Describe potential Vector Control issues: <br /> 5. TOILET/BATH FACILITIES: / <br /> Number and Location(s)of existing facilities: -�Z- f—Z 12p.�/ f�L CIG, �1�7�� �• <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> 7. GENERAL SANITATION: <br /> List any problem(s) not previously noted: <br /> S. POPULATION DENSITY: <br /> Approximate number of people per square mile: ( � � 5�� /. , <br /> --H 06 06 Report 47201 lune 30,2008 <br />