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NOTE: PULL ALL 5 :MITS (Septic, Well, etc.) . MAKE ( a IES FOR FILE " <br /> 1. SEWAGE: <br /> Distance to Public Sewers: Connection Necessary? F Yes �No <br /> Does Existing Septic System comply with San Joaquin County Development Title? Yes ❑ No Unknown <br /> If no,explain: <br /> Describe Septic System to be installed ��` � � i� <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well? ❑ Yes fj—No Is well properly sealed and constructed? F-1 Yes No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? F] Yes [2-No Is Public Water System Permit current? E] Yes ❑ No <br /> Does existing or proposed use make this a Public Water System ? M Yes No <br /> Is water/well sampling current? 7 Yes F-1 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): yr� 2��i <br /> 4. FLY MOSQUITO OR VECTOR CONTROL: <br /> Describe potential Vector Control issues: <br /> 5. TOILET 1 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: za-j � <br /> 5H 06 06 Report#7201 March 21,2006 <br />