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f c <br /> NOTE: PULL AL6,MMITS (Septic, Well, etc.) MAWOPIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: Connection Necessary? lies 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: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well? 7 Yes 7 No Is well properly sealed and constructed ? 0 Yes No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? 0 Yes ❑ 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? F-� Yes No <br /> Additional information or comments: <br /> 3. GARBAGE& REFUSE: <br /> Licensed scavenger pick-up? F--j Yes ❑ No Service Area No. <br /> Other proposed disposal method: <br /> Potential Problem(s): <br /> j 4. FLY MOS UITO OR VECTOR CONTROL: <br /> C Describe potential Vector Control issues: <br /> k 5. TOILET I BATH FACILITIES: <br /> Number and Location(s)of existing facilities: <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> r <br /> I <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 W7201 Page 2 lune 21,2004 <br /> i <br />