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NOTE: PULL ALL\,_RMITS (Septic, Well, etc.) MAKE _JPIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: AeVAL Connection Necessary ? Ej Yes [No <br /> Does Existing Septic System comply with San Joaquin County Development Title? [Z 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 ? 7 Yes 0 No Is well properly sealed and constructed ? [2] Yes Ej No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? F-1 Yes [R No Is Public Water System Permit current? Yes No <br /> Does existing or proposed use make this a Public Water System ? ❑ Yes Ej No <br /> Is water/well sampling current ? F-1 Yes F-1 No 2 <br /> Additional information or comments: <br /> 3. GARBAGE& REFUSE: <br /> Licensed scavenger pick-up? F-1 Yes F-] No 1 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: N14 <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: RG-/yam, AE3-42g1- j <br /> Eli 06 06 Report 47201 Page 1 May 24,2004 <br />