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NOTE: PULL ALRMITS (Septic, Well, etc.) MAKE%..oJPiES FOR FILE ; <br /> 1. SEWAGE: <br /> Distance to Public Sewers: N Connection Necessary? Yes [5-7i'o <br /> Does Existing Septic System comply with San Joaquin County Development Title? Yes �No E] Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: -. <br /> �. <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well? 0-Yes E] No Is well properly sealed and constructed ? D—Tes E No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? Yes No Is Public Water System Permit current? Yes No <br /> Does existing or proposed use make this a Public Water System ? E-1 Yes E]—No <br /> Is water I well sampling current? ❑ Yes DNo <br /> Additional information or comments: <br /> 3. GARBAGE & REFUSE: <br /> Licensed scavenger pick-up? El Yes ❑ No Service Area No. <br /> Other proposed disposal method: <br /> Potential Problem(s): <br /> 4. FLY, MOSOUITO OR VECTOR CONTROL: <br /> Describe potential Vector Control issues: <br /> 5. TOILET I 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 /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> EH 06 06 Report 97201 Page 2 June 21.2004 <br />