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NOTE: PULL A1,L; =RMITS {Se'tic, Well, etc.} MAKE PIES FOR FILE <br /> I. 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 /> E <br /> Describe Septic System to be installed: <br /> �f <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? ❑ Yes ❑ No Is well properly sealed and constructed ? ❑ Yes ❑ No <br /> Describe deficiency, if any: <br /> E <br /> Is well system a Public Water system ? ❑ Yes ❑ No Is Public Water System Permit current? ❑ Yes ❑ No <br /> t <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 /> i <br /> 3. GARBAGE&REFUSE: <br /> Licensed scavenger pick-up? ❑ Yes 0 No Service Area No. <br /> Other proposed disposal method: t <br /> Potential Problem(s): <br /> I <br /> 4. FLY MOS UITO OR VECTOR CONTROL: <br /> Describe potential Vector Control issues: <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 /> I <br /> March 31,2008 <br /> Eld 06 06 Report 47201 <br />