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NOTE: PULL. ALL%WtRMITS (Septic, Well, etc.) MAKE IPIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: Q''t> f Connection Necessary ? F� Yes F.FrNo <br /> Does Existing Septic System comply with San Joaquin County Development Title? Yes No 1/n Unknown <br /> If no, explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? J4 Yes ❑ No Is well properly sealed and constructed ? J71 Yes ❑ No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? ❑ Yes No Is Public Water System Permit current? Yes F_j No <br /> Does existing or proposed use make this a Public Water System ? F-] Yes F_� No <br /> Is water 1 well sampling current? ❑ Yes ❑ No <br /> Additional information or comments: <br /> 3. GARBAGE&REFUSE: <br /> Licensed scavenger pick-up? Yes F-1 No Service Area No. <br /> Other proposed disposal method: <br /> Potential Problem(s): Z2'2 z-' <br /> 4. FLY,MOSQUITO OR VECTOR CONTROL: <br /> Describe potential Vector Control issues: �, ¢.-, y.. ef�. <br /> 5. TOILET/BATH FACILITIES: <br /> Number and Location(s)of existing facilities: :. _ r r!!"?, <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 07201 March 23,2009 <br />