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NOTE: PULL ALL ,, AMITS (Septic, Well, etc.) MAKE kv,P1ES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: L7&' Connection Necessary ? EJ'Yes F-1 No ��vv/��(- <br /> Does Existing Septic System comply with San Joaquin County Development Title? E] Yes F-1No �Uek/wm <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? ❑ Yes LJ No Is well properly sealed and constructed? ❑ Yes ❑ No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? ❑ Yes 0 No Is Public Water System Permit current? 0 Yes ❑ No <br /> Does existing or proposed use make this a Public Water System ? ❑ Yes No <br /> Is water/well sampling current ? F] Yes F-1 No <br /> Additional information or comments: <br /> 3. GARBAGE&REFUSE: <br /> Licensed scavenger pick-up? [if 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: Yf/_ A9Mli�A. <br /> /H?'7d� L g .q &,*- Y ) <br /> 5. TOILET/BATH FACILITIES: <br /> Number and Location(s)of existing facilities: :Z,CWL (f1 6-1 W� <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> 7. GENERAL SANITATION: <br /> List any problem(s) not previously noted: ,CIA <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: �6�//7_11�3'✓.S7S'/ <br /> EH 06 06 Report#7201 February 07,2006 <br />