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NOTE: PULL ALL L,; ..IMITS (Septic, Well, etc.) MAKE I,.,j?IES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: c�1'Y Connection Necessary ? ❑ Yes eNo <br /> Does Existing Septic System comply with San Joaquin County Development Title ? Yes ❑ No [a Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> t <br /> 2. WATER SUPPLY: <br /> No Is well properly sealed and constructed ? es No <br /> Is Water supplied by Private Well ? El Yes <br /> Describe deficiency, if any- <br /> Is well system a Public Water system ? F-� Yes ED-'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 1 well sampling current ? F1 Yes ❑ No <br /> Additional information or comments: <br /> S <br /> i <br /> 3. GARBAGE&REFUSE: <br /> Licensed scavenger pick-up? P7F- es ❑ No Service Area No. <br /> Other proposed disposal method: <br /> rPotential Problem(s): <br /> C <br /> 4. FLY MOS UITO OR VECTOR CONTROL: <br /> F Describe potential Vector Control issues: <br /> S. TOILET/BATH FACILITIES: <br /> Number and Location(s)of existing facilities: Y7P <br /> k 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 97201 June 20,2007 <br />