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NOTE: PULL ALLRMITS (Septic, Well, etc.) MAK PIES FOR PILE ' <br /> i 1. SEWAGE: <br /> Distance to Public Sewers: Connection Necessary? F-1 Yes ❑ No <br /> Does Existing Septic System comply with San Joaquin County Development Title ? Yes No F-] Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> i <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? ❑ Yes 0 No Is well properly sealed and constructed ? F-1 Yes ❑ No <br /> Describe deficiency, if any: <br /> Is well system a Public Water system ? 7 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 F-1 No <br /> Is water/well sampling current? E-1 Yes F� No <br /> Additional information or comments: <br /> 3. GARBAGE &REFUSE: <br /> Licensed scavenger pick-up? [—] Yes F-] 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 1 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#7201 <br /> November 16,2009 <br />