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i <br /> I s-� <br /> NOTE: PULL ALL%moeRMITS (Septic, Well, etc.) MAKE%si6PIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: Connection Necessary ? ❑ Yes [P/No <br /> Does Existing Septic System comply with San Joaquin County Development Title? F-1 Yes No <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? F] Yes ❑ No Is well properly sealed and constructed ? F-1 Yes ❑ No <br /> Describe deficiency, if any: <br /> E Is well system a Public Water system ? [__j Yes [7] No Is Public Water System Permit current? F-1 Yes F-1 No <br /> Does existing or proposed use make this a Public Water System ? F� Yes ❑ No <br /> Is water/well sampling current? ❑ Yes ❑ No <br /> Additional information or comments: <br /> 9 <br /> 3. GARBAGE&REFUSE: <br /> Licensed scavenger pick-up? ❑ Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential Problem(s): <br /> a <br /> 4. FLY,MOSQUITO OR VECTOR CONTROL: <br /> Describe potential Vector Control issues: AM- <br /> 5. TOILET/BATH FACILITIES: <br /> Number and Location(s)of existing facilities: <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION II:ISTORY: <br /> , <br />} <br /> 7. GENERAL SANITATION: <br /> List any problem(s) not previously noted: <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: /119 <br /> EH 06 06 Report 47201 September 15,2008 <br />