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NOTE: PULL ALL RMITS (Septic, Well, etc.) MAKEe,;PIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: 70-�5r Connection Necessary? F] Yes ZT 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 /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? �s Q No Is well properly sealed and constructed ? Yes 0 No <br /> Describe deficiency, if any: <br /> Is well system a Public Water system ? F-1 Yes �No Is Public Water System Permit current? Yes L] No <br /> Does existing or proposed use make this a Public Water System? F� Yes E] No <br /> Is water 1 well sampling current? F—] Yes F-1 No <br /> Additional information or comments: <br /> 3. GARBAGE&REFUSE: <br /> Licensed scavenger pick-up? E]'es No Service Area No. <br /> Other proposed disposal method: <br /> Potential Problem(s): /1r,� ►� / _ <br /> 4. FLY MOSQUITO OR VECTOR CONTROL: <br /> Describe potential Vector Control issues: <br /> 5. TOILET I BATH FACILITIES: <br /> Number and Location(s)of existing facilities: <br /> Additional facilities required: <br /> h• PREVIOUS OPERATION HISTORY: <br /> f <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 June 22,2009 <br /> i <br />