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NOTE: PULL ALL^RMITS (Septic, Well, etc.) MAKE _)PIES FOR FILE <br /> 1. SEWAGE: / <br /> Distance to Public Sewers: Connection Necessary ? E] Yes E3 No <br /> Does Existing Septic System comply with San Joaquin County Development Title ? Yes No Unkno <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> SER SUPPLY: <br /> Is Water supplied by Private Well ? F—] Yes F-] No Is well properly sealed and constructed ? ❑ Yes [—] No <br /> Describe deficiency, if any: <br /> well system a Public Water system ? ❑ Yes F—] No 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 ? ❑ Yes F-] No <br /> Additional information or comments: <br /> S. GARBAGE & REFUSE: <br /> Licensed scavenger pick-up? F-1 Yes 7 No Service Area No. <br /> Other proposed disposal method: <br /> otential 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 /> 7. GENERAL SANITATION: <br /> List any problem(s) not previously noted: <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> EH 06 06 Report 97201 sepiemb"24 2001 <br />