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NOTE: PULL ALL i i,tMITS (Septic, Well, etc.) MAKE �_,PIES FOR FILE <br /> 1. <br /> SEWAGE- <br /> Distance <br /> EWAGE:Distance to Public Sewers: Connection Necessary? F-1 Yes No <br />} Does Existing Septic System comply with San Joaquin County Development Title ? ❑ Yes ❑ No <br /> Unknown <br /> i If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well? Yes E5 No Is well properly sealed and constructed ? E3—Vcs No <br /> Describe deficiency,if any: <br /> i <br /> Is well system a Public Water system ? [:] Yes ,D—No Is Public Water System Permit current? Q Yes No <br /> Does existing or proposed use make this a Public Water System ? r-j Yes No <br /> Is water/well sampling current? [--j Yes No <br /> Additional information or comments: <br /> 3. GARBAGE&REFUSE: <br /> Licensed scavenger pick-up? es ❑ 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: i <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> 7. GENERAL SANITATION: <br /> List any problem(s) not previously noted: <br /> I <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> 1 <br /> 3 <br /> i <br /> H 06 06 Report#7201 <br /> November 08,2006 <br /> i <br />