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v d <br /> NOTE: PULL ALL.-ERMITS (Septic, Well, etc.) MAKL OPIES FOR FILE <br /> 1. SEWAGE• <br /> Distance to Public Sewers: Connection Necessary? 0 yes F-1 No <br /> Does Existing Septic System comply with San Joaquin County Development Title? Yes No <br /> Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well? ❑ Yes E] No Is well properly scaled 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? F-� Yes No <br /> Is water/well sampling current? F—] Yes F—] 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 MOSQUITO OR VECTOR CONTROL: <br /> Describe potential Vector Control issues: <br /> 5. TOILET 1 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 /> S. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> EH 06 06 Report##7201 Page 1 May 10,2004 <br />