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NOTE: PULL ALL .RMITS (Septic, Well, etc.) MAKE PIES FOR FILE <br /> I. SEWAGE: <br /> Distance to Public Sewers: Connection Necessary? C] Yes No <br /> Does Existing Septic System comply with San Joaquin County Development Title? E] Yes E] No Unknown <br /> If no,explain- <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? F-1Yes F-1NoIs well properly sealed and constructed ? Yes No <br /> Describe deficiency, if any: <br /> Is well system a Public Water system ? F-1 Yes [] No Is Public Water System Permit current? ❑ Yes ❑ No <br /> Does existing or proposed use make this a Public Water System ? F1 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 F-1 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: <br /> Additional facilities required: <br /> b. 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 /> ?H 06 06 Report 97201 November 07,2007 <br />