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NOTE: PULL ALL%..RMITS (Septic, Well, etc.) MAKE Z, PIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: ��,� Connection Necessary? ❑ Yes ❑ No <br /> Does Existing Septic System comply with San Joaquin County Development Title ? E] Yes ❑ No Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> t Is Water supplied by Private Well ? 0 Yes 121,No Is well properly scaled and constructed ? ❑ Yes F-1 No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? Yes ❑ No Is Public Water System Permit current? Ej 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 No Service Area No. <br /> Other proposed disposal method: <br /> Potential Problem(s): <br /> I <br /> 4. FLY,MOSQUITO OR VECTOR CONTROL: <br /> Describe potential Vector Control issues: <br /> a <br /> 5. TOILET/BATH FACILITIES: <br /> Number and Location(s)of existing facilities: <br /> Additional facilities required: <br />+ 6. PREVIOUS OPERATION HISTORY: <br /> i <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 /> '-H 06 06 Report#7201 July 24,2007 <br />