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NOTE. PULL ALL r'IMITS (Septic, Well, etc.) MAKE. PIES FOR FILE x <br /> I. SEWAGE: <br /> Distance to Public Sewers: / /ea) Connection Necessary? [ Yes No <br /> AJ <br /> Does Existing Septic System comply with San Joaquin County Development Title ? E] Yes Ej No Ean <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? ❑ Yes La/No Is well properly sealed and constructed ? Yes E] No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? E Yes E] No Is Public Water System Permit current? Yes No <br /> Does existing or proposed use make this a Public Water System ? F-� Yes No <br /> Is water/well sampling current? 7 Yes No . <br /> Additional information or comments: <br /> 3. GARBAGE& REFUSE: <br /> Licensed scavenger pick-up? 0 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: �IA <br /> 5. TOILET/BATH FACILITIES: <br /> Number and Location(s)of existing facilities: <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> C <br /> 7. GENERAL SANITATION: <br /> List any problem(s)not previously noted <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: � Tt <br /> EH 06 06 Report#7201 Page 2 June 21,2004 <br /> I <br />