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NOTE: PULL AL -VERMITS (Septic, Well, etc.) MAK COPIES FOR FILE <br /> I. SEWAGE: <br /> Distance to Public Sewers: <br /> —_ Connection Necessary " D�Yes E] No <br /> Does Existing Septic System comply with San Joaquin County Development Title ? 0 Yes No F-1 L�rrksn <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? F] Yes [] 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 F-1 No <br /> Does existing or proposed use make this a Public Water System ? r--] Yes No <br /> Is water/well sampling current? 7 Yes ❑ No <br /> Additional information or comments: <br /> 3. GARBAGE &REFUSE: <br /> Licensed scavenger pick-up? EYYes n No Service Area No. <br /> Other proposed disposal method.- <br /> Potential <br /> ethod:Potential Problem(s): <br /> I <br /> 4. FLY,MOSQUITO OR VECTOR CONTROL: <br /> Describe potential Vector Control issues: 'G' ,��j <br /> 5. TOILET/BATH FACILITIES: <br /> Number and Location(s)of existing facilities: <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> �<r <br /> 7. GENERAL SANITATION: <br /> List any problem(s) not previously noted: <br /> I <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: J <br /> i <br /> I <br /> EH 06 06 Report IM01 June 20,2008 <br />