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NOTE: PULL ALL 6.,IMITS (Septic, Well, etc.) MAKE CIES FOR FILE ' <br /> 1. SEWAGE: <br /> Distance to Public Sewers: /�� — Connection Necessary? F-� Yes IJ No <br /> Does Existing Septic System comply with San Joaquin County Development Title ? ❑ Yes F] No U�i <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? 531 Yes F] No. Is well properly sealed and constructed ? ❑ Yes E21"No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? 0 Yes No Is Public Water Syst in Permit current? F] Yes 0 No <br /> Does existing or proposed use make this a Public Water System ? � Yes No <br /> Is water/well sampling current? r—] Yes M No <br /> Additional information or comments: <br /> 3. GARBAGE&REFUSE: <br /> Licensed scavenger pick-up? F1 Yes u 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 /> S. TOILET/BATH FACILITIES: <br /> Number and Location(s)of existing facilities: AllA <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> &4 <br /> 7. GENERAL SANITATION: <br /> List any problem(s)not previously noted: 4-114- <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: f/ <br />!H 06 06 Report#7201 August 28,2006 <br />