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NOTE: PULL ALL Pc-AMITS (Septic, Well, etc.) MAKE C.-PIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: Connection Necessary? Yes E] No <br /> Does Existing Septic Sstem comply with San Joaquin County Development Title? Yes No Unknown <br /> If no,explain.• l <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well? [✓ Yes F-1 No Is well properly sealed and constructed ? Yes Q No <br /> Describe deficiency,if any: =,lrj(-2,) ALeXAW,< ct� ''¢p/M266&'��7 m l <br /> Is well system a Public Water system? ❑ Yes M No Is Public Water System Permit current? E] Yes No <br /> Does existing or proposed use make this a Public Water System? ❑ Yes No <br /> Is water/well sampling current? ❑ Yes 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: 1A <br /> 5. TOILET/BATH FACILITIES: <br /> Number and Location(s)of existing facilities: A J14 <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: Zat) ,p � (�yyB�Yrj <br /> EH 0606 Report#7201 Paue' I ���� -1°- <br />