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NOTE: PULL A -PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> 1. SEWAGE: / <br /> Distance to Public Sewers: /V� _ Connection Necessary ? ❑ Yes Eo/No <br /> Does Existing Septic System comply with San Joaquin County Development Title? es F-] No F-1 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 ❑ No Is well properly sealed and constructed ? Yes ❑ No <br /> Describe deficiency, if any: <br /> Is well system a Public Water system ? 0 Yes No Is Public Water System Permit current? Yes E] No <br /> Does existing or proposed use make this a Public Water System? ❑ Yes F—,VNo <br /> Is water/well sampling current? ❑ Yes ❑ No <br /> Additional information or comments: <br /> 3. GARBAGE& REFUSE: <br /> 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 /> 5. TOILET/BATH FACILITIES: <br /> Number and Location(s) of existing facilities: / <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> I <br /> 7. GENERAL SANITATION: <br /> I <br /> List any problem(s) not previously noted: <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: � •7 <br /> EH 06 06 Report#7201 <br /> April 19,2010 <br />