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NOTE: PULL ALL%.,,.RMITS (Septic, Well, etc.) MAKE,jPIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: Connection Necessary? ❑ Yes No <br /> Does Existing Septic System comply with San Joaquin County Development Title ? E] Yes No F1 Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> r <br /> r <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? ❑ Yes E] No Is well properly sealed and constructed ? F-1 Yes No <br /> Describe deficiency,if any: <br /> 7 <br /> Is well system a Public Water system ? ❑ Yes F-1 No Is Public Water System Permit current ? ❑ Yes No <br /> Does existing or proposed use make this a Public Water System ? F1 Yes F-1 No <br /> Is water/well sampling current? 0 Yes F� No <br /> Additional information or comments: <br /> I <br /> i <br /> 3• GARBAGE&REFUSE: <br /> Licensed scavenger pick-up? F� Yes ❑ No Service Area No. : <br /> Cher proposed disposal method: <br /> i <br /> Potential Problem(s): <br /> 4. FLY MOSQUITO OR VECTOR CONTROL: <br /> Describe potential Vector Control issues: i <br /> E <br /> i 5. TOILET/BATH FACILITIES: <br /> Number and Location(s)of existing facilities: i <br /> Additional facilities required: <br /> 6• PREVIOUS OPERATION HISTORY: <br /> 7. GENERAL SANITATION: <br /> List any problem(s) not previously noted: <br /> i <br /> S. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> EH 06 06 Report 97201 July 10,2007 <br />