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I. SEWAGE: NOTE: PULL ALLY„�,RMJTS (Septic, Well, etc.) MAKE'' iP1ES FOR FILE <br /> Distance to Public Sewers: Connection Necessary ? 0 Yes Q No <br /> Does Existing Septic System comply with San Joaquin County Development Title ? ❑ Yes F-� No Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: `�� � <br /> Is Water supplied by Private Well? Yes No Is well properly sealed and constructed ? D---Yes ❑ No <br /> Describe deficiency,if any: <br /> Is wells stem a Public Waters stem ? . Yes No Is Public W -' "— <br /> Y Y Water System Permit current? Yes No <br /> Does existing or proposed use make this a Public Water System ? n Yes No <br /> Is water/well sampling current? ❑ Yes n No <br /> Additional information or comments: <br /> J• GARBAGE&REFUSE: <br /> Licensed scavenger pick-up? / Yes n 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: Z21J21 <br /> 5. TOILET/BATH FACILITIES: <br /> Number and Location(s)of existing facilities: y / ����. - K <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> „/- i�/moi-�vir. l <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 97201 August 11,2008 <br />