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1 NOTE: PULL ALL RMITS (Septic, Well, etc.) MAKE +1.401ES FOR FILE t <br /> 1. SEWAGE: <br /> Distance to Public Sewers: l Connection Necessary? © Yes F-1 No <br /> Does Existing Septic System comply with San Joaquin County Development Title ? ❑ Yes No (E Lwidiyvn <br /> If no, explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? ❑ Yes © No Is well properly sealed and constructed ? ❑ Yes ❑ No <br /> Describe deficiency, if any: <br /> Is well system a Public Water system ? 0 Yes ❑ No Is Public Water System Permit current? ❑ Yes F-1 No <br /> Does existing or proposed use make this a Public Water System ? ❑ Yes No <br /> Is water/well sampling current? F-1 Yes No <br /> Additional information or comments: <br /> 3. GARBAGE& REFUSE: <br /> Licensed scavenger pick-up? ® Yes F-1NoService Area No. <br /> Other proposed disposal method: <br /> Potential Problem(s): <br /> 4. FLY, MOSQUITO OR VECTOR CONTROL: <br /> Describe potential Vector Control issues: _1,,Z- <br /> 5. TOILET/BATH FACILITIES: <br /> Number and Location(s)of existing facilities: 42La471;-PL- ,/` 71 <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> 7. GENERAL SANITATION: <br /> List any problem(s)not previously noted: 1-114 <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: yrJjr`j�J Zr%yj2 _a <br /> M 06 06 Report 47201 January 25,2010 <br />