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a <br /> NOTE: PULL ALL%, ,RMITS (Septic, Well, etc.) MAKE,.,OPIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: Connection Necessary? ❑ Yes fj"No <br /> Does Existing Septic System comply with San Joaquin County Development Title ? Yes No F,7[-'Unknown <br /> If no, explain: <br /> Describe Septic System to be installed: <br /> l <br /> F <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? 0Y-6s ❑ No Is well properly sealed and constructed ? F,—+-Ves ❑ No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? ❑ Yes LD--1Vo Is Public Water System Permit current? E] Yes 0 No <br /> Does existing or proposed use make this a Public Water System ? ❑ 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? Q-1—es F-� No Service Area No. <br /> Other proposed disposal method: <br /> Potential Problem(s): y,� <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: r � <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 /> EH 06 06 Report 47201 January 25,2008 <br />