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1. SEWAGE: NOTE: PULL ALI. RIVIITS (Septi¢, (Nell, etc.) MAwc', jkPIES FOR FILE <br /> � <br /> Distance to Public Sewers: �a Connection Necessary? <br /> Does Existing Septic System comply with San Joaquin County Development Title Yes Yes No <br /> If no,explain: ❑ LJ lxo ❑ Unknown <br /> Describe Septic System to be installed: <br /> t <br /> h <br /> 2. WATER-SUPPLY- <br /> Is <br /> ATERSUPPLY:Is Water supplied by Private Well ? es ❑ No Is well properly sealed and constructed ? es <br /> Describe deficiency,if any: ❑ No <br /> Is well system a Public Water system ? ❑ yes ❑ No Is Public Water System Permit current? ❑ YesNo <br /> Yes Does existing or proposed use make this a Public Water System ? ❑ <br /> Is water/well sampling ❑ ❑ No <br /> p g curren t ? ❑ Yes ❑ No <br /> Additional information or comments: <br /> 3. GARBAGE&REFUSE: <br /> Licensed scavenger pick-up? Yes ❑ 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: <br /> 5. TOILET/BATH FACILITIES: <br /> Number and Location(s)of existing facilities: <br /> l <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#7201 <br /> March 07,2006 <br />