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NOTE: PULL ALL�,wRMITS (Septic, Well, etc.) MAKE WPIES FOR FILE <br /> 1. SEWAGE: <br /> J <br /> Distance to Public Sewers:_ Connection Necessary . El Yes Ej'No <br /> Does Existing Septic System comply with San Joaquin County Development Title? Yes No Q'Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? 'es No Is well properly sealed and constructed? ��Yes No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? F-1 Yes E3 "o 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? ❑ Yes ❑ No <br /> Additional information or comments: <br /> 3. GARBAGE& REFUSE: <br /> k 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 /> O <br /> 5. TOILET/BATH FACILITIES: <br /> Number and Location(s)of existing facilities: �- p <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> 7. GENERAL SANITATION: <br /> List any problem(s)not previously notedo�� _ <br /> 8. POPULATION DENSITY: <br />` Approximate number of people per square mile: c�`� <br /> EH 06 06 Report 47201 Page 1 May 24,2004 <br />