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NOTE: PULL ALL L,4elM ITS (Septic, Well, etc.) MAKE RIES FOR FILE ' <br /> 1. SEWAGE: <br /> Distance to Public Sewers: Z( A Connection Necessary? ❑ Yes No <br /> Does Existing Septic System comply with San Joaquin County Development Title ? Yes No [2f Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? 1 Yes f--] No Is well properly sealed and constructed ? 9 Yes E] No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? F] Yes No Is Public Water Syst m Permit current? F-1YesNo <br /> Does existing or proposed use make this a Public Water System ? ElYesEYNo <br /> Is water/well sampling current? 0 Yes F-1 No <br /> Additional information or comments: <br /> 3. GARBAGE&REFUSE: <br /> { <br /> Licensed scavenger pick-up? ❑ Yes DNo Service Area No. <br /> Other proposed disposal method: <br /> Potential Problem(s): <br /> Q. FLY,MOSOUITO OR VECTOR CONTROL: <br /> s <br /> Describe potential Vector Control issues: <br /> S. TOILET/BATH FACILITIES: <br /> Number and Location(s)of existing facilities: c.ro <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 /> 106 06 Report#17201 <br /> July 24,2006 <br />