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NOTE: PULL ALL%RMITS (Septic, Well, etc,) MAKE c,-;„ypIES FOR FILE ' <br />1. SEWAGE: <br />Distance to Public Sewers: 7 Connection Necessary ? [a Yes Ej No <br />Does Existing Septic System comply with San Joaquin County Development Title ? Yes No U� <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 <br />Describe deficiency, if any: <br />Is well properly sealed and constructed ? F-1 - Yes ❑ No <br />Is well system a Public Water system ? F� Yes El 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 ? 0 Yes ❑ No <br />Additional information or comments: <br />3. GARBAGE & REFUSE: <br />Licensed scavenger pick-up? L;Yes No <br />Otber proposed disposal method: <br />Potential Problem(s): <br />Service Area No. : <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. PREVI�OU�S OPERATION HISTORY: <br />7. GENERAL SANITATION: <br />List any problem(s) not previously noted:A/�j,� <br />S. POPULATION DENSITY: <br />Approximate number of people per square mile: _� <br />:H 06 06 Report #7201 August 03, 2006 <br />