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0 <br /> NOTE: PULL ALL RMITS (Septic, Well, etc.) MAKEl�IES FOR FILE t <br /> 1. SEWAGE: <br /> Distance to Public Sewers: Connection Necessary? E] Yes Ej No <br /> Does Existing Septic System comply with San Joaquin County Development Title ? [] Yes 0 No ❑ Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? F-1YesNo Is well properly sealed and constructed? Yes No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? F-1 Yes D No Is Public Water System Permit current? Yes No <br /> Does existing or proposed use make this a Public Water System ? F'� Yes E] No <br /> Is water 1 well sampling current? [:] Yes F-1 No <br /> Additional information or comments: <br /> 3. GARBAGE&REFUSE: <br /> Licensed scavenger pick-up? E] Yes F-1 No Service Area No. <br /> Other proposed disposal method: <br /> Potential Problem(s): <br /> 4. FLY,MOSOUITO 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 /> 1 <br /> 8. POPULATION DENSITY: <br /> M Approximate number of people per square mile: <br /> EH 06 06 Report 47201 Page 2 May 24,2004 <br />