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NOTE. PULL ALL-ERMITS (Septic, Well, etc.) MAKE ,_OPIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: VIA Connection Necessary ? ❑ Yes [2'No <br /> Does Existing Septic System comply with San Joaquin County Development Title? [a Yes E] No Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: �—�( <br /> Is Water supplied by Private Well ? I�I Yes E] No Is well properly sealed and constructed ? Q Yes No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? E Yes EZ No Is Public Water System Permit current ? Yes No <br /> Does existing or proposed use make this a Public Water System ? 7 Yes No <br /> Is water/well sampling current ? ❑ Yes [__j No <br /> Additional information or comments: <br /> 3. GARBAGE& REFUSE: <br /> Licensed scavenger pick-up? 1z Yes F—] No Service Area No. <br /> Other proposed disposal method: <br /> Potential Problem(s): <br /> 4. FLY, MOSOUITO OR VECTOR CONTROL: <br /> Describe potential Vector Control issues: <br /> 5. TOILET/ BATH FACILITIES: <br /> Number and Location(s)of existing facilities: c9,Uc <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 Report#7201 Page 2 June 21.2n04 <br />