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[p <br /> F- <br /> NOTE: PULL ALL MITS (Septic, Well, etc.) MAKE L=OIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: .r✓1�,� Connection Necessary? 0 Yes E2�'No <br /> Does Existing Septic System comply with San Joaquin County Development Title? EK Yes E] No 2 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 No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? ❑ Yes [j1 No Is Public Water Sys em 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: �A <br /> —r <br /> 5. 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 /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: ���Ct/� <br /> :N 06 06 Report 97201 October 03,2006 <br />