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NOTE: PULL ALL REMITS (Septic, Well, etc.) MAKE C AES FOR FILE <br /> 1. SEWAGE: ,/ <br /> Distance to Public Sewers:_ �[/. Connection Necessary ? [—] Yes dNo <br /> Does Existing Septic System comply with San Joaquin County Development Title? Ej Yes No Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? ❑ Yes ar No Is well properly sealed and constructed ? 2" Yes 0 No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? E] Yes []j No Is Public Water Syspm 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 /> Licensed scavenger pick-up? LYJ 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 /> 7. GENERAL SANITATION: <br /> List any problem(s) not previously noted:. <br /> S. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> sH 06 06 Report#7201 May 08,2007 <br />