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NOTE: PULL ALL ERMITS (Septic, Well, etc.) MAKk JOPIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: x A Connection Necessary ? 7 Yes ER No <br /> Does Existing Septic System comply with San Joaquin County Development Title ? Ej Yes ❑ No ❑ Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? t� Yes ❑ No Is well properly sealed and constructed ? Ea Yes ❑ No <br /> Describe deficiency, if any: <br /> Is well system a Public Water system ? L✓_I —Ye—S -9No Is Public Water System Permit current ? Yes 0 No <br /> Does existing or proposed use make this a Public Water System ? ❑ Yes ❑ No <br /> Is water/well sampling current ? El Yes ❑ No <br /> Additional information or comments: <br /> 3• GARBAGE & REFUSE: <br /> Licensed scavenger pick-up? d 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: /6'q <br /> , <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: uZc..i'. 5� <br /> EH 06 06 Report#7201 Page 2 June 21,2004 <br />