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fff NOTE: PULL ALL {I IMITS (Septic, Well, etc.) MAKE ( PIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: oa Connection Necessary ? 0 Yes ,�No <br /> Does Existing Septic System comply with San Joaquin County Development Title? Ej Yes 2—No ❑ Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: i <br /> Is Water supplied by Private Well? E3— ees O No Is well properly sealed and constructed ? El Yes E] No <br /> Describe deficiency,if any: <br /> Is well..system a Public Water system ? [] Yes No Is Public Water System Permit current? Yes No <br /> Does existing or proposed use make this a Public Water System ? 7 Yes E] No <br /> .Is water/well sampling current? ❑ Yes No <br /> Additional information or comments: <br /> 3. GARBAGE&REFUSE: <br /> Licensed scavenger pick-up? F] Yes O-T o Service Area No. <br /> Other proposed disposal method: <br /> Potential Problem(s): <br /> 4. FLY MOSQ 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 /> G. PREVIOUS OPERATION HISTORY: <br /> 7. GENERAL SANITATION: <br /> List any problem(s) not previously noted: d <br /> S. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> -E1-106 06 Report#7201 April 04,2006 <br />