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NOTE: PULL ALL P'IRMITS (Septic, Well, etc.) MAKE C.-n+IES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: Connection Necessary? EEj- Yes No <br /> Does Existing Septic System comply with San Joaquin County Development Title? Yes No Unknown <br /> If no,explain: /t,�,4 <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? Fv Yes F-1 No Is well properly sealed and constructed ? Yes Q' No <br /> Describe deficiency,if any: -XZb(—y) <br /> Is well system a Public Water system? F-1 Yes Q No Is Public Water�S—y—s}tem Permit current? Yes No <br /> Does existing or proposed use make this a Public Water System? F-1LJ Yes No <br /> Is water/well sampling current? E] Yes EZ No <br /> Additional information or comments: <br /> 3. GARBAGE&REFUSE: <br /> Licensed scavenger pick-up? M 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: AZA <br /> 5. TOILET/BATH FACILITIES: <br /> Number and Location(s)of existing facilities: X-11,4 <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> Gl! <br /> r-n <br /> 7. GENERAL SANITATION: <br /> List any problem(s) not previously noted <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: [ptJ 14�Aesaizgkoz� <br /> EH 06 06 Report#7201 Page 1 May 12.2004 <br />