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(Septic,_ ) . <br /> NOTE: PULL ALL tM1T3Well, etc. MAKE IES FOR FILE ,.,,....... <br /> 1. SEWAGE: <br /> Distance to Public Sewers-- ��.� Connection Necessary ? EJ Yes EjNo <br /> Does Existing Septic System comply with San Joaquin County Development Title? EZYes ❑ No F-1 Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? ER Yes ❑ No Is well properly sealed and constructed ? Yes No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? 0 Yes E]tNo Is Public Water System Permit current? Yes No <br /> Does existing or proposed use make this a Public Water System ? ❑ Yes E2"'No <br /> Is water/well sampling current? ❑ Yes F-1 No <br /> Additional information or comments: <br /> 3. GARBAGE&REFUSE: <br /> Licensed scavenger pick-up? ❑ 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 /> 5. TOILET/BATH FACILITIES: <br /> Number and Location(s)of existing facilities: — 11 <br /> Additional facilities required: <br /> 6. PREVIOUS OPERA'T'ION HISTORY: <br /> 1411-, <br /> 7. GENERAL SANITATION: <br /> List any problem(s) not previously noted: X40f <br /> S. POPULATION DENSITY: <br /> Approximate number of people per square mile: J r <br /> H 06 06 Report 47201 February 22,2006 <br />