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NOTE: PULL ALL tMITS (Septic, Well, etc.) MAKE CIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: �- Connection Necessary? ❑ Yes ❑ 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 /> -2 f s <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? Eg- Yes ❑ No Is well properly scaled and constructed ?,R] Yes No <br /> Describe deficiency,if any: <br /> Is well system a Public Water syste <br /> m'.' ❑ Yes No Is Public Water System Permit current? Yes No <br /> Does existing or proposed use mas a is Water System? ❑ Yes No <br /> Is water/well sampling current? Yes No <br /> Additional information or comme <br /> 3. GARBAGE&REFUSE: <br /> Licensed scavenger pick-up? ❑ 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 issue' <br /> 5. TOILET/BATH FACILITIES: <br /> Number and Location(s)of existing facilities: <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> 7. GENERAL SANITATION: <br /> List any problem(s) not previously noted: _ <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> EH 06 06 Report 97201 March 14,2006 <br />