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NOTE: PULL ALL .RMITS (Septic, Well, etc.) MAKE PIES FOR FILE <br /> SEWAGE: <br /> Distance to Public Sewers: A Connection Necessary? : Yes Q 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 /> WATER SUPPLY: <br /> t Is Water supplied by Private Well ? Yes Ej No Is well properly sealed and constructed :' Yes No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? 0 Yes 0 No Is Public Water System Permit current ? F7 Yes No <br /> Does existing or proposed use make this a Public Water System ? F-1 Yes No <br /> Is water/well sampling current ? F-� Yes n No <br /> Additional information or comments: <br /> 3. GARBAGE& REFUSE: <br /> Licensed scavenger pick-up? E� 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: <br /> 5. TOILET/ BATH FACILITIES: <br /> Number and Location(s)of existing facilities: �.Ci-cJ ._�d�ih�+✓.�z ��j j>j� j <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> Z � <br /> 7. GENERAL SANITATION: <br /> List any problem(s) not previously noted: X14 <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> 'H 06 06 Report H7201 July 05.2007 <br />