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-117 <br /> NOTE: PULL ALL RMITS (Septic, Well, etc.) MAKEOOPIES FOR FILE <br /> 1. SEWAGT_ <br /> Connection Necessary ? ❑ ❑Yes No <br /> Distance to Public Sewers: ❑ Unknown <br /> Does Existing Septic System comply with San Joaquin County Development Title? E] yes ❑ No <br /> If no,explain- <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> ❑is Water supplied by Private Well? Yes [:] No Is well properly sealed and constructed? ❑ Yes ❑ No <br /> Describe deficiency,if any: <br /> I <br /> Is well system a Public Water system? ❑ Yes ❑ No Is Public Water System Permit current? ❑ Yes No <br /> Does existing or proposed use make this a Public Water System? ❑ Yes ❑ No <br /> i Is water/well sampling current? ❑ Yes ❑ No <br /> Additional information or comments: <br /> 3. GARBAGE&REFUSE: <br /> i 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 /> t <br /> 5. TOILET/BATH FACILITIES: <br /> Number and Location(s)of existing facilities: <br /> Additional facilities required: <br /> b. 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 07201 March 23,2009 <br />