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NOTE: PULL ALL' RMITS (Septic, Well, etc.) MAKE `'PIES FOR FILE <br /> I. SEWAGE: bar <br /> Distance to Public Sewers: ::1_- L2 Connection Necessary? Yes No <br /> Does Existing Septic System comply with San Joaquin County Development Title ? Yes ❑ No 144&4ow n <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well? Yes allo Is well properly sealed and constructed ? Yes No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? E] Yes allo Is Public Water System Permit current? Yes No <br /> Does existing or proposed use make this a Public Water System ? Yes No <br /> Is water/well sampling current? ❑ Yes F-1 No <br /> Additional information or comments: <br /> 3. GARBAGE & REFUSE: <br /> Licensed scavenger pick-up? Yes F-1 No Service Area No. <br /> Other proposed disposal method: <br /> Potential Problem(s): <br /> 4. FLY MOS UITO OR VECTOR CONTROL: <br /> Describe potential Vector Control issues: ^ ,y/ <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: �G <br /> EH 06 06 Report 97201 Page 2 lune 21,2004 <br /> i <br />