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NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br />I. SEWAGE: <br />Distance to Public Sewers: Connection Necessary ? Yes No <br />Does Existing Septic System comply with San Joaquin County Development Title ? Yes 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� Yes Ej No <br />Describe deficiency, if any: <br />Is well properly sealed and constructed ? F] Yes F] No <br />Is well system a Public Water system ? F-1 Yes F] No Is Public Water System Permit current ? F] Yes 0 No <br />Does existing or proposed use make this a Public Water System ? F—] Yes No <br />Is water / well sampling current ? F-1 Yes F-� No <br />Additional information or comments: <br />3. GARBAGE & REFUSE: <br />Licensed scavenger pick-up? F-1 Yes F-] 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 / 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 />Service Area No. : <br />EH 06 06 Report #7201 August 28, 2018 <br />