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NOTE: PULL ALLk---RMITS (Septic, Well, etc.) MAKE PIES FOR BILE <br /> L SEWAGE: <br /> Distance to Public Sewers: <br /> Connection Necessary ? El Yes ❑ No Title ? <br /> Does Existing Septic System comply with San Joaquin County Development <br /> If no,explain: El Yes ❑ No ❑ Unknown <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? ❑ Yes ❑ No Is well properly sealed and constructed ? ❑ <br /> Describe deficiency,if any: Yes ❑ No <br /> Is well system a Public Water system ? ❑ Yes ❑ No Is Public Water System Permit current . <br /> Does existing or proposed use make this a Public Water System ? ❑ Yes No <br /> ❑ Yes ❑ No <br /> Is water/well sampling current ? ❑ <br /> Additional information or comments Yes ❑ No <br /> 3• GARBAGE&REFUSE, <br /> Licensed scavenger pick-up? Yes <br /> ❑ ❑ No Service Area No. <br /> Other proposed disposal method: <br /> Potential Problem(s): <br /> 4. FLY MOS UITO 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 /> 5. PREVIOUS OPERATION HISTORY: <br />'. GENERAL SANITATION: <br /> List any problem(s) not previously noted: <br /> POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> r6 06 Report 47201 <br /> February 21,2007 <br />