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NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br />SEWAGE: <br />Distance to Public Sewers: Connection Necessary? LI Yes n No <br />Does Existing Septic System comply with San Joaquin County Development Title? El Yes Ei No 0 Unknown <br />If no, explain: <br />Describe Septic System to be installed: <br />WATER SUPPLY: <br />Is Water supplied by Private Well? El Yes p No Is well properly sealed and constructed ? Yes No <br />Describe deficiency, if any: <br />Is well system a Public Water system? Yes 0 No Is Public Water System Permit current? 0 Yes 0 No <br />Does existing or proposed use make this a Public Water System? 0 Yes No <br />Is water / well sampling current? El Yes El No <br />Additional information or comments: <br />GARBAGE & REFUSE: <br />Licensed scavenger pick-up? Ei Yes El No Service Area No. : <br />Other proposed disposal method: <br />Potential Problem(s): <br />FLY, MOSQUITO OR VECTOR CONTROL: <br />Describe potential Vector Control issues <br />TOILET / BATH FACILITIES: <br />Number and Location(s) of existing facilities: <br />Additional facilities required: <br />PREVIOUS OPERATION HISTORY: <br />GENERAL SANITATION: <br />List any problem(s) not previously noted: <br />POPULATION DENSITY: <br />Approximate number of people per square mile: <br />EH 06 06 Report #7201 February 25, 2019