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NOTE: PULL ALL RMITS (Septic, Well, etc.) MAKE L*90PIES FOR FILE <br /> 1. SEWAGE: , 1 <br /> Distance to Public Sewers: Connection Necessary ? ❑ Yesy�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? [ZYes 0 No Is well properly sealed and constructed? 2 Yes ❑ No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? 0 Yes a No Is Public Water Sys m Permit current? � Yes E] No <br /> Does existing or proposed use make this a Public Water System ? ❑ Yes YNa <br /> Is water/well sampling current? ❑ Yes ❑ No <br /> Additional information or comments: <br /> 3. GARBAGE& REFUSE: <br /> Licensed scavenger pick-up? Yes F-� No Service Area No. <br /> Other proposed disposal method: <br /> Potential Problem(s): <br /> 4. FLY MOS UITO OR VECTOR CONTROL: <br /> Describe potential Vector Control issues: 4A <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: , IA <br /> S. POPULATION DENSITY: <br /> Approximate number of people per square miler <br /> EH 06 06 Report#7201 April 17,2007 <br />