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NOTE: PULL ALL RMITS (Septic, Well, etc.) MAKE,_PIES FOR FILE <br /> N <br /> 1. SEWAGE: } <br /> Distance to Public Sewers: Connection Necessary? E] Yes No ! <br /> Does Existing Septic System comply with San Joaquin County Development Title ? Yes No Unknown i <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> E <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well? ❑ Yes No is well properly sealed and constructed ? ❑ Yes ❑ No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? ❑ Yes ❑ No 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 ? 0 Yes ❑ No 'I <br /> Additional information or comments: <br /> 3. GARBAGE&REFUSE: <br /> Licensed scavenger pick-up? 7 Yes No Service Area No. <br /> Other proposed disposal method: <br /> i <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 /> 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 /> A 06 06 Report 47201 July 10,2007 <br />