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NOTE._. <br /> PULL ALL OWAMITS (Septic, Well, etc.) MAKE SPIES FOR FILE " <br /> 1. SEWAGE _—.._...� <br /> Distance to Public Sewers:. /X7� _ Connection Necessary ? D Yes ;�71 No <br /> Does Existing Septic System comply with San Joaquin County Development Title ? Yes No a Unknown <br /> If no, explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well? Yes 0 No Is well properly sealed and constructed ? V�' Yes ❑ No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? Ej Yes E----]'No Is Public Water System Permit current? ❑ Yes F-� No j <br /> Does existing or proposed use make this a Public Water System ? ❑ Yes ❑ No ' <br /> Is water/well sampling current? ❑ Yes ❑ No <br /> Additional information or comments: <br /> 3. GARBAGE&REFUSE: <br /> Licensed scavenger pick-up? 0 Yes F-� 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: / �•-� ,�,,,v I <br /> i <br /> i <br /> I <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 February 24,2009 <br /> I <br />