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NOTE: PULL ALL LwAMITS (Septic, Well, etc.) MAKE IES FOR FILE ' <br /> I. SEWAGE: <br /> Distance to Public Sewers: A0 Connection Necessary? ❑ Yes ErNo ; <br /> Does Existing Septic System comply with San Joaquin County Development Title ? Yes F-1 No ❑ Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? Yes No Is well properly scaled and constructed ? Yes 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 ? Yes No <br /> Is water/well sampling current ? F1 Yes ❑ No <br /> Additional information or comments: <br /> 3. GARBAGE& REFUSE: <br /> Licensed scavenger pick-up? ❑ Yes E-1 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: C /u� 2CE JdAj <br /> Additional facilities required: <br /> 6• PREVIOUS OPERATION HISTORY: <br /> 7. GENERAL SANITATION: <br /> List any problem(s) not previously noted: <br /> IV <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> E14 06 06 Report 47201 <br /> February 22,2006 <br />