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NOTE: PULL ALL�.,RMITS (Septic, Well, etc.) MAKEt..,,dP1ES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: Connection Necessary? ❑ Yes E] No <br /> Does Existing Septic System comply;with San Joaquin County Development Title ? Yes No Unknown ,f <br /> If no,explain: <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 ? F-1 Yes F-1 No <br /> Describe deficiency,if any: <br /> Is wcll system a Public Water system ? 7 Yes E] No Is Public Water System Permit current? 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? ❑ 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 1 BATH FACILITIES: <br /> Number and Locatiou(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 /> 8. POPULATION DENSITY: ..- <br /> Approximate number of people per square mile: <br />:H 06 06 Report 97201 <br /> July 03,2006 <br />