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NOTE: PULL ALL_ RMITS (Septic, Well, etc.) MAKE PIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: '44Connection Necessary ? ❑ Yes Q No <br /> Does Existing Septic System comply with San Joaquin County Development Title ? Yes No Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? EYes 0 No Is well properly sealed and constructed ? 7 Yes Eo' No <br /> Describe deficient if an At,- &�- i" <br /> y' y' /r1LL' ��4a <-- � �' �`?�1.�'/tet:--s �r Zri &-inz - <br /> Is well system a Public Water system ? ❑ Yes E]2No Is Public Water System Permit current? F-1 Yes [a No <br /> Does existing or proposed use make this a Public Water System ? F1 Yes No <br /> Is water/well sampling current ? F-1 Yes F-1 No <br /> Additional information or comments: <br /> 3. GARBAGE& REFUSE: <br /> Licensed scavenger pick-up? F-1 Yes F-] 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 HISTORY: <br /> &-e <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 /> 5H 06 06 Report#7201 March 20,2007 <br />