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NOTE: PULL A 'ERMITS (Septic, Well, etc.) MAKr..aOP1ES FOR FILE <br /> I. SEWAGE: <br /> Distance to Public Sewers:_ �_ �kY 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 /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well? [—] Yes J2'No Is well properly sealed and constructed ? ❑ Yes F] No <br /> Describe deficiency, if any: <br /> Is well system a Public Water system ? Yes ❑ No Is Public Water System Permit current? �Ycs 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 /> 3. GARBAGE&REFUSE: <br /> Licensed scavenger pick-up? L-7-:i�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: <br /> 5. TOILET f 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. <br /> EH 06 06 Report#7201 June 27,2005 <br />