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NOTE: PULL ALL...�RMITS (Septic, Well, etc.) MAKEvoOPiES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: Connection Necessary? F-� Yes ;,0 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 ? F-/1,l es E] No Is well properly sealed and constructed ? Yes 0 No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? 0 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 F-1 No <br /> Is water/well sampling current? F-1 Yes F-1 No <br /> Additional information or comments: <br /> 3. GARBAGE& REFUSE: <br /> Licensed scavenger pick-up? [( des No Service Area No. : <br /> Other proposed disposal method: <br /> Potential Problem(s): 41y 2e Yt;-�ypvh' <br /> 4. FLY,MOSQUITO OR VECTOR CONTROL: <br /> Describe potential Vector Control issues: ��.� L' •.-�..r�i� <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 /> S. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> EH 06 06 Report 87201 <br /> March 16,2009 <br />