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NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: Connection Necessary? Ej Yes F-] No <br /> Does Existing Septic System comply with San Joaquin County Development Title? F] Yes D No E] Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well? 0-Ries 0 No Is well properly sealed and constructed? Ej Yes E No <br /> Describe deficiency, if any: c a <br /> Is well system a Public Water system ? 0 YesNo 1sdPublic Water System Permit current? Yes ❑ No <br /> Does existing or proposed use make this a Public WaterSystem?y7 en Yes 0 No <br /> Is water/well sampling current? F Yes No <br /> Additional information or comments: ;1 <br /> fs <br /> d <br /> 3. GARBAGE & REFUSE: ;jr, <br /> Licensed scavenger pick-up? E] Yes D No Sr ice Area Nay: <br /> Other proposed disposal method: [L�� <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 /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> EH 06 06 Report#7201 October 12,2017 <br />