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NOTE: PULL ALL `AMITS (Septic, Well, etc.) MAKE L-�PIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: Connection Necessary ? Ej Yes No - <br /> Does Existing Septic System comply with San Joaquin County Development Title? Ej Yes ❑ No E Unknown <br /> If no, explain: <br /> Describe Septic System to be installed: <br /> WATER SUPPLY: <br /> Is Water supplied by Private Well ? E] Yes No Is well properly sealed and constructed ? El Yes No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? ,,Fl Yes F-1 No Is Public Water System Permit current ? Ej Yes D No <br /> Does existing or proposed use make this a Public Water System ? 0 Yes No <br /> Is water/well sampling current ? F-1 Yes F-] No <br /> Additional information or comments: <br /> ' GARBAGE& REFUSE: p� <br /> Licensed scavenger pick-up? 1=1 <br /> - 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: <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> 7. GENERAL SANITATION: <br /> List any problem(s) not previously noted: <br /> S. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> H 06 06 Report 87201 May I8,2007 <br />