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MOTE: PULL ALL p HITS (Septic, Well, etc.) MAKE CaIKES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Severs: Connection Necessary ? Yes �� No <br /> Does Existing Septic System compl} with San ,loaquin County Development Title ? Yes T No F_� Unknown <br /> If no, explain; / R <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? E] Yes No Is well properly sealed and constructed ? LiYes D No <br /> Describe deficiency, if any: <br /> Is well system a Public Water system '! F-1Yes No Is Public Water System Permit current? ❑ Yes F-1No <br /> Does existing or proposed use make this a Public Water System ? ❑ Yes ❑ No <br /> Is water 1 Nvell sampling current ? ❑ Yes No <br /> Additional information or comments: <br /> 3. GARBAGE & REFUSE: <br /> Licensed scavenger pick-up? r--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 MSTORY: <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 /> 1106 06 Report X17201 April 02,2010 <br />