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NOTE: PULL ALL&wcRMITS (Septic, Well, etc.) MAKEPIES FOR FILE <br /> 1. SEWAGE: J <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 /> Describe Septic System to be installed: <br /> Z. WATER SUPPLY: <br /> Is Water supplied by Private Well? r-1 Yes [E]'�No Is well properly sealed and constructed ? ❑ Yes E] No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? F� Yes o Is Public Water System Permit current? Yes No <br /> Does existing or proposed use make this a Public Water System ? E] Yes No <br /> Is water I well sampling current? F-1 Yes F—] No <br /> Additional information or comments: <br /> 3. GARBAGE&REFUSE: <br /> Licensed scavenger pick-up? 0 Yes No Service Area No. : <br /> Other proposed disposal method: <br /> Potential Problem(s)- <br /> 4. FLY,MOSOUITO 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. <br /> ISTORY: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 January 18,2006 <br />