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NOTE: PULL ALL%,,RMITS (Septic, Well, etc.) MAKE PIES FOR FILE <br /> 1, SEWAGE: <br /> Distance to Public Sewers: Connection Necessary? El Yes 9 No <br /> Does Existing Septic System comply with San Joaquin County Development Title ? 19 Yes E] No Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? [J YesNo Is well properly sealed and constructed ? Yes No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? Ej Yes [� No Is Public Water System Permit current ? Yes No <br /> Does existing or proposed use make this a Public Water System ? F-1 Yes Ej No <br /> Is water/well sampling current? ❑ Yes ❑ No <br /> Additional information or comments: <br /> 3. GARBAGE&REFUSE: <br /> Licensed scavenger pick-up? 12, <br /> 2J Yes ❑ No Service Area No. : <br /> Other proposed disposal method: <br /> Potential Problem(s).- <br /> 4. <br /> roblem(s):4. FLY MOSQUITO OR VECTOR CONTROL: <br /> Describe potential Vector Control issues: T AId-61 <br /> _ <br /> 5. TOILET/BATH FACILITIES: <br /> Number and Location(s)of existing facilities: ?7i = / i/D 32 4-1- <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: _ ` �(,�f�f ��"' AL <br /> EH 06 06 Report 97201 May 11,2007 <br />