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L SEWAGE: NOTE: PULL ALERMITS (Septic, Well, etc.) MAKEp1ES FQR FILE <br /> Distance to Public Sewers: -____> Connection Necessary? ❑ Yes <br /> No <br /> Does Existing Septic System comply with San Joaquin County Development Title? ❑ Yes ❑ <br /> If no,explain: No Unknown <br /> Describe Septic System to be installed: <br /> 2• WATER SUPPLY: <br /> Is Water supplied by Private Well ? ❑ No Is well properly sealed and constructed ? es ❑ <br /> Describe deficiency, if any: No <br /> Is well system a Public Water system ? ❑ yes No Is Public Water System Permit current? ❑ Yes <br /> Does existing or proposed use make this a Public Water System? [:j Yes N ❑ No <br /> Is water/well sampling current? [:] N <br /> Yes ❑. o <br /> ❑ o <br /> Additional information or comments: <br /> 3. GARBAGE&REFUSE: ` <br /> Licensed scavenger pick-up? es ❑ No Service Area No. : - <br /> Other proposed disposal method: <br /> Potential Problem(s): <br /> 4. FLY MOS UITO,OR VECTOR CONTROL: <br /> Describe potential Vector Control issues: <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 /> 8. POPULATION DENSITY- <br /> Approximate number of people per square mile: <br /> EH 06 06 Report;17201 <br /> May 25,2010 <br />