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I. SEWAGE: NOTE: PULL ALL :RMITS (Septic, Well, etc.) MAKE,,,,�)PIES FOR FILE <br /> Distance to Public Sewers: Connection Necessary? [] Yes F-1 No <br /> Does Existing Septic System comply with San Joaquin County Development Title ? Yes No Unknown <br /> If no,explain: <br /> s <br /> Describe Septic System to be installed: j <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? E] Yes ❑ No Is well properly sealed and constructed ? ❑ Yes F] No <br /> Describe deficiency,if any: <br /> I <br /> Is well system a Public Water system ? [] Yes F-] No Is Public Water System Permit current? Yes No <br /> Does existing or proposed use make this a Public Water System ? F-1 Yes ❑ No <br /> Is water 1 well sampling current? ❑ Yes ❑ No <br /> Additional information or comments: <br /> 3. GARBAGE&REFUSE: <br /> Licensed scavenger pick-up? ❑ Yes 0 No Service Area No. : <br /> Other proposed disposal method: <br /> Potential Problem(s): i <br /> i <br /> 4. FLY,MOSQUITO OR VECTOR CONTROL: <br /> Describe potential Vector Control issues: <br /> 5. TOILET 1 BATH FACILITIES: <br /> Number and Location(s)of existing facilities: <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> i <br /> i <br /> i <br /> I <br /> 7. GENERAL SANITATION: i <br /> List any problem(s) not previously noted: <br /> 8. POPULATION DENSITY: <br /> F <br /> Approximate number of people per square mile: <br /> • k <br /> a <br /> EH 06 06 Report 47201 July 31,2007 <br /> I <br />