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NOTE: PULL ALL MITS (Septic, Well, etc.) MAKE CIES FOR FILE <br /> 1. SEWAGE: i <br /> Distance to Public Sewers: r,7 CM Connection Necessary ? F-1 Yes 0"'No <br /> Does Existing Septic System comply with San Joaquin County Development Title ? F-1 Yes F� No V7r Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well? .E]Yes ❑ No Is well properly sealed and constructed ? , Yes F] No <br /> Describe deficiency, if any: a �, <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 No <br /> Is water/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/BATH FACILITIES: <br /> Number and Location(s)of existing facilities: �r .p <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> 7. GENERAL SANITATION: <br /> List any problem(s) not previously noted: <br /> S. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> :I-I 06 06 Report#7201 April 02,2010 <br />