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NOTE: PULL ALL .RMITS (Septic, Well, etc.) MAKE SPIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: Connection Necessary ? ❑ Yes F� No <br /> Does Existing Septic System comply with San Joaquin County Development Title? Yes Fj No ❑ Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> &2WATER SUPPLY: <br /> Is Water supplied by Private Well ? Yes ❑ No Is well properly sealed and scong0truelted? FYespNo <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? ❑ Yes F-1 No Is Public Water System Permit current? ❑ Yes No <br /> J <br /> s existing or proposed use make this a Public Water System ? Yes No <br /> ater/well sampling current ? Yes No <br /> ditional 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 /> FLY, MOSQUITO OR VECTOR CONTROL: <br /> Describe potential Vector Control issues: _ <br /> 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 /> POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> EH 06 06 Report#7201 May 19,2009 <br />