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NOTE: PULL ALL AMITS (Septic, Well, etc.) MAKE �..3IES FOR FILE <br /> SEWAGE: <br /> Distance to Public Sewers: It/ Connection Necessary ? Ej Yes [a No <br /> 'Does Existing Septic System comply with San Joaquin County Development Title ? E'Yes ❑ No 0 Unknown <br /> If no,explain: <br /> Septic System to be installed: <br /> 2. WATER SUPPLY: �--�( <br /> Is Water supplied by Private Well ? 1- Yes F-1 No Is well properly sealed and constructed ? D Yes No <br /> Describe deficiency, if any: <br /> Is well system a Public Water system ? F� Yes E2r No Is Public Water Syst m Permit current ? E] YesNo <br /> Does existing or proposed use make this a Public Water System ? ❑ Yes System <br /> Is water/well sampling current ? ❑ Yes F-1 No <br /> Additional information or comments: <br /> 3. GARBAGE & REFUSE: <br /> Licensed scavenger pick-up? Q Yes F-1 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: 1�),wlwe <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> 7. GENERAL SANITATION: <br /> List any problem(s) not previously noted: <br /> S. POPULATION DENSITY: <br /> Approximate number of people per square mile: � <br /> EH 06 06 Repon 47201 July 10,2007 <br />