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NOTE: PULL ALL RMITS (Septic, Well, etc.) MAKE t.,$'PIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: ��i�' Connection Necessary ? ❑ Yes Eallo <br /> Does Existing Septic System comply with San Joaquin County Development Title? 0 Yes No E2rUnknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> Z. WATER SUPPLY: <br /> Is Water supplied by Private Well ? Yes ❑ No Is well properly sealed and constructed ? 1z Yes No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? 0 Yes No Is Public Water Syst m.Permit current? F-1YesNo <br /> Does existing or proposed use make this a Public Water System ? F-1YesEFNo <br /> Is water 1 well sampling current? ❑ Yes ❑ 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: <br /> Additional facilities required: <br /> h• 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: [ / <br /> EH 06 06 Report 47201 January 30,2007 <br />