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NOTE: PULL ALL :RMITS (Septic, Well, etc.) MAKE (PIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: 7W' 7? Connection Necessary? ❑ Yes QNo <br /> Does Existing Septic System comply with San Joaquin County Development Title ? ❑ Yes ❑ No Unknown <br /> If no, explain: z 7l� <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? �es 0 No Is well properly sealed and constructed ? L��cs ❑ No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system? Ej 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? M Yes F-1 No <br /> Additional information or comments: <br /> 3. GARBAGE & REFUSE: <br /> Licensed scavenger pick-up? ❑ Yes n No Service Area No. <br /> Other proposed disposal method: � �xz✓�7 <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: ' ,p• <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: ,J f <br /> FH 06 06 Report#7201 <br /> March 16,2009 <br />