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NOTE: PULL ALL RMITS (Septic, Well, etc.) MAKE 6. CIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: Connection Necessary ? ❑ Yes [2"No <br /> Does Existing Septic System comply with San Joaquin County Development Title? Yes ❑ No Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? ©/Yes F-� No Is well properly sealed and constructed ? [—] Yes D 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 1 well sampling current? ❑ Yes ❑ No <br /> Additional information or comments: <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,MOSQUITO OR VECTOR CONTROL: <br /> Describe potential Vector Control issues: <br /> 5. TOILET 1 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: e <br /> S. POPULATION DENSITY: <br /> Approximate number of people per square mile: � �S/7y <br /> :H 06 06 Report#7201 January 25,2010 <br />