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NOTE: PULL ALL ,,_r2MITS (Septic, Well, etc.) MAKE .,SPIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: Connection Necessary ? ❑ Yes Q No <br /> Does Existing Septic System comply with San Joaquin County Development Title? ®,Yes E] No F] Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: l—� <br /> Is Water supplied by Private Well? Yes L_f No Is well properly sealed and constructed ? Yes No <br /> Describe deficiency,if any: ,L"-1 <br /> Is well system a Public Water system ? ❑ Yes ,�Ro Is Public Water System Permit current ? Yes No <br /> Does existing or proposed use make this a Public Water System ? F-1 Yes F-1 No <br /> Is water/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,MOSQUITO OR VECTOR CONTROL: <br /> Describe potential Vector Control issues: <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 April 12,2006 <br />