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NOTE: PULL ALL £ MITS (Septic, Well, etc.) MAKE SWIES FOR FILE ' <br /> 1. SEWAGE: <br /> Distance to Public Sewers: Connection Necessary ? C] Yes No <br /> Does Existing Septic System comply with San Joaquin County Development Title? ❑ 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? F� Yes [D`No Is well properly sealed and constructed ? ❑ Yes No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? ❑ Yes ❑ No Is Public Water System Permit current? ❑ Yes No <br /> Does existing or proposed use make this a Public Water System ? ❑ Yes No <br /> Is water/well sampling current? [:] Yes ❑ No <br /> Additional information or comments: <br /> { 1 <br /> r .,.. <br /> 3. GARBAGE&REFUSE: <br /> Licensed scavenger pick-up? F71—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 /> ....... <br /> 5. TOILET I BATH FACILITIES: <br /> Number and Location(s)of existing facilities: M <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 /> Ell 06 06 Report 47201 September 04,2009 <br />