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+ NOTE: PULL AL �,ERMITS (Septic, Well, etc.) MAM.OPIES FOR FILE z. <br /> I. SEWAGE: <br /> Distance to Public Sewers: V/A 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 /> r <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well? Ea No Is well properly sealed and constructed ? Yes ED-"'No <br /> Describe deficiency,if any: <br /> F <br /> Is well system a Public Water system ? ❑ Yes E2--'No Is Public Water System Permit current? ❑ Yes Eg�o <br /> t Does existing or proposed use make this a Public Water System ? ❑ Yes? E] No <br /> Is water/well sampling current? ❑ Yesl F] No <br /> Additional information or comments: <br /> 3. GARBAGE& REFUSE: <br /> Licensed scavenger pick-up? E] 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 /> S. TOILET I BATH FACILITIES: <br /> Number and Location(s)of existing facilities: <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> l <br /> 7. GENERAL SANITATION: <br /> List any problem(s) not previously noted <br /> I 8. POPULATION DENSITY: <br /> r <br /> Approximate number of people per square mile: 1 . <br /> I <br /> EH 06 06 Report 47201 Page 2 June 21,2004 <br />