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NOTE: PULL ALL�?RMITS (Septic, Well, etc.) MAKE-,.,bPIES 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? Yes No <br /> If no, explain: <br /> ❑ ❑ ❑ Unknown <br /> Describe Septic System to be installed: <br /> 'r <br /> 2. WATER SUPPLY: <br /> C Is Water supplied by Private Well ? Yes No Is well properly sealed and constructed ? ❑ ❑ <br /> ❑ ❑ p P y Yes No <br /> Describe deficiency, if any: <br /> Is well system a Public Water system? ❑ Yes ❑ No Is Public Water System Permit <br /> Does existing or proposed use make this a Public Water System ? [:] Yes F-1No <br /> current . El Yes E] No <br /> Is water I well sampling current? ❑ Yes ❑ No <br /> Additional information or comments: <br /> 3. GARBAGE&REFUSE: <br /> Licensed scavenger pick-up? ❑ Yes ❑ No Service Area No. <br /> Other proposed disposal method: <br /> Potential Problem(s): <br /> 4. FLY MOS UITO OR VECTOR CONTROL: <br /> i° <br /> Describe potential Vector Control issues: <br /> t <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 /> February 08,2008 <br />