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1. SEWAGE: NOTE: PULL ALL(_,,RMITS (Septic, Well, etc.) MAKE,jPIES FOR FILE <br /> Distance to Public Sewers: T Connection Necessary? ❑ Yes ErNo <br /> Does Existing Septic System comply with San Joaquin County Development Title ? Yes E] No J Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? 2-Yes E] No Is well properly sealed and constructed ? Yes ❑ No <br /> Describe deficiency, if any: Loeff <br /> Is well system a Public Water system ? ❑ Yes No Is Public Water System Permit current? Yes ❑ No <br /> Does existing or proposed use make this a Public Water System ? ❑ Yes F-1 No <br /> Is water/well sampling current? 0 Yes [:] No <br /> Additional information or comments: <br /> 3. GARBAGE&REFUSE: <br /> Licensed scavenger pick-up? EYYes F-1 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: <br /> Additional facilities required: <br /> 5. 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#7201 <br /> May 09,2006 <br />