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NOTE: PULL ALL MITS (Septic, Well, etc.) MAKE CIES FOR FILE <br /> I. SEWAGE <br /> Distance to Public Sewers: - �YsJ" Connection Necessary ? 0 Yes O/No <br /> Does Existing Septic System comply with San Joaquin County Development Title? Yes Ejy No Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? 0 Yes ❑ No Is well properly sealed and constructed ? Yes No <br /> Describe deficiency, if any: <br /> Is well system a Public Water system ? ❑ Yes ❑ No 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: i�s�rx3ifz/P <br /> s � <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 MOS UITO OR VECTOR CONTROL: <br /> Describe potential Vector Control issues: <br /> 5. TOILET/BATH FACILITIES: <br /> Number and Location(s)of existing facilities: zz <br /> ? <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> r <br /> 7. GENERAL SANITATION: <br /> List any problem(s)not previously noted: /may <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> :H 06 06 Report#7201 January 25,2010 <br />