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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 ENo <br /> Does Existing Septic System comply with San Joaquin County Development Title? Q'Yes ❑ No F-1 Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? 5_;rYes ❑ No Is well properly sealed and constructed ? EaYes ❑ No <br /> Describe deficiency, if any: <br /> Is well system a Public Water system ? ::] Yes a No Is Public Water System Permit current ? Yes No <br /> Does existing or proposed use make this a Public Water System ? ❑ Yes E�rNo <br /> Is water/well sampling current ? ❑ Yes ❑ No <br /> Additional information or comments: <br /> 3. GARBAGE& REFUSE: <br /> Licensed scavenger pick-up? d Yes F-1 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 /> T <br /> 5. TOILET/BATH FACILITIES: <br /> Number and Location(s) of existing facilities: �E — <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> 7. GENERAL SANITATION: <br /> List any problem(s) not previously noted: W4 <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per squa re mile: A ,�ej <br /> EH 06 06 Report#7201 July 25,2006 <br />