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NOTE: PULL ALL^^cRMITS (Septic, Well, etc.) MAKE eJP1ES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: Connection Necessary ? Yes No <br /> Does Existing Septic System comply with San Joaquin County Development Title? 10/Yes F—] No [__1 Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? EV Yes [—] No Is well properly sealed and constructed ? 2 Yes F—] No <br /> Describe deficiency, if any: <br /> Is well system a Public Water system ? F—] Yes ® No Is Public Water System Permit current? F—] Yes F—] No <br /> Does existing or proposed use make this a Public Water System? F-] Yes F� No <br /> Is water/well sampling current? M Yes M No <br /> Additional information or comments: <br /> 3. GARBAGE & REFUSE: <br /> Licensed scavenger pick-up? M 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: Zz' <br /> 5. TOILET/BATH FACILITIES: <br /> Number and Location(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: j/W <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> Al 06 06 Report 47201 <br /> Mav 22 2001, <br />