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NOTE: PULL ALL tMITS (Septic, Well, etc.) MAKE {,,, IES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: <br /> Connection Necessary? [:] Yes No <br /> Does Existing Septic System comply with San Joaquin County Development Title? l Yes E] No ❑ Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well? 2/yes F-1No Is well properly sealed and constructed? E2/yesNo <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? ❑ Yes 1 No Is Public Water System Permit current? ❑ Yes ❑ No <br /> Does existing or proposed use make this a Public Water System? ❑ Yes E�rNo <br /> Is water/well sampling current? ❑ Yes ❑ No <br /> Additional information or comments: <br /> 3. GARBAGE&_REFUSE-- �f <br /> Licensed scavenger pick-upI Yes ❑ No Service Area No. <br /> Other proposed disposal method: <br /> s <br /> Potential Problem(s): <br /> I 4. FLY MOS UITO 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 /> i <br /> 8. rOPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> } <br /> May 17,2006 <br /> j EH 06 06 Report 47201 <br />