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NOTE: PULL ALL, .RMITS (Septic, Well, etc.) MAKE )PIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: Connection Necessary ? [:] Yes allo <br /> Does Existing Septic System comply with San Joaquin County Development Title ? Yes No �Ila�e v�x <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well? D Yes Eja� 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 ? F] Yes F-1 No <br /> Additional information or comments: <br /> 3. GARBAGE& REFUSE: <br /> Licensed scavenger pick-up? EO' Yec F—] 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: A11A <br /> 5. TOILET/BATH FACILITIES: <br /> Number and Location(s)of existing facilities: AtLllz <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> G//hi7f�.z7L")a5 - _ Azf__� <br /> . GENERAL SANITATION: <br /> List any problem(s) not previously noted: X-14- <br /> . POPULATION DENSITY: <br /> Approximate number of people per square mile: ',�/ � <br /> EH 06 06 Report#7201 August 25.2008 <br />