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NOTE: PULL ALL tMITS (Septic, Well, etc.) MAKE � ___,?IES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: 1t�� Connection Necessary ? F-1 Yes No <br /> Does Existing Septic System comply with San Joaquin County Development Title ? ER Yes ❑ No 0 Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? Eif Yes F-1 No Is well properly sealed and constructed ? Yes No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? ❑ Yes Ej�'No Is Public Water System Permit current? Yes No <br /> Does existing or proposed use make this a Public Water System ? ❑ Yes ErNo <br /> Is water/well sampling current ? F-] Yes F—] No <br /> Additional information or comments: <br /> 3. GARBAGE& REFUSE: <br /> Licensed scavenger pick-up? E� Yes F—] 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: Qjj f /% d 1 <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> A9 <br /> 7. GENERAL SANITATION: <br /> hist any problem(s) not previously noted: ,�,1VA <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: �fc� fit/L���� (g;�nl <br /> EH 06 06 Report#7201 August 01,2006 <br />