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1. SEWAGE: NOTE: PULL ALL MITS (Septic, Well, etc.) MAKE 6.40IES FOR FILE <br /> Distance to Public Sewers: Connection Necessary ? [] Yes Ej No <br /> Does Existing Septic System comply with San Joaquin County Development Title? ® Yes F� No <br /> 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 ? 01 Yes El No <br /> Describe deficiency,if any: f� <br /> �' u-� Fe art rCiL� <br /> Is well system a Public Water system ? Yes No Is Public Water System Permit current? [j Yes No <br /> Does existing or proposed use make this a Public Water System ? F_j Yes ❑ No <br /> Is water/well sampling current? ❑ Yes No <br /> Additional information or comments: <br /> 3. GARBAGE&REFUSE: <br /> Licensed scavenger pick-up? ❑ Yes 0 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: <br /> S. POPULATION DENSITY: - <br /> Approximate number of people per square mile: <br /> EH 06 06 Report#7201 <br /> June 27,2006 <br /> n <br /> _dry <br /> 1 <br />