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NOTE: PULL ALL 2MITS (Septic, Well, etc.) MAKE PIES FOR FILE <br /> SEWAGE: <br /> Distance to Public Sewers: 'Y)r Connection Necessary ? ❑ Yes No <br /> Does Existing Septic System comply with San Joaquin County Development Title? E] Yes ❑ No E] Unknown <br /> If no,explain: - <br /> ribe Septic System to be installed: <br /> WATER SUPPLY: <br /> Is Water supplied by Private Well? L[ Yes ❑ No Is well properly sealed and constructed ? E] Yes ❑ No <br /> Describe deficiency, if any: <br /> Is well system a Public Water system ? F] Yes 0 No Is Public Water System 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 /> GARBAGE & REFUSE: <br /> Licensed scavenger pick-up? Yes ❑ No Service Area No. <br /> Other proposed disposal method: <br /> otential Problem(s): <br /> Y, 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 /> 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: J ,� <br /> EH 06 06 Report#7201 r <br />