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NOTE: PULL ALL _,.RMITS (Septic, Well, etc.) MAKE �— PIES FOR FILE <br /> SEWAGE: <br /> Distance to Public Sewers: Connection Necessary ? ❑ Yes ❑ No <br /> Does Existing Septic System comply with San Joaquin County Development Title ? Yes ❑ No Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> WATER SUPPLY: <br /> Is Water supplied by Private Well ? Yes 0 No Is well properly sealed and constructed ? E] Yes No <br /> Describe deficiency, if any: �a� W f <br /> u c <br /> Is well system a Public Water system ? 7 Yes 7 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? 7 Yes ❑ No <br /> Additional information or comments: <br /> OWL— <br /> GARBAGE&REFUSE: <br /> Licensed scavenger pick-up? ❑ Yes No Service Area No. <br /> Other proposed disposal method: _ <br /> Potential Problem(s): <br /> FLY, MOSQUITO OR VECTOR CONTROL: <br /> Describe potential Vector Control issues: <br /> TOILET/BATH FACILITIES: <br /> Number and Location(s)of existing facilities: <br /> Additional facilities required: <br /> PREVIOUS OPERATION HISTORY: <br /> GENERAL SANITATION: <br /> List any problem(s) not previously noted: <br /> POPULATION DENSITY: <br /> Approximate number of people per square miler <br /> 06 Report#7201 April"'7.2007 <br />