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NOTE: PULL ALL"I-ERMITS (Septic, Well, etc.) MAKE SPIES FOR FILE <br /> 1. SEWAGF: <br /> Distance to Public Servers: Connection Necessary ? 0 Yes Ej No <br /> Does Existin Septic System comply with San Joaquin County Development Title ? Yes ❑ No 0 Unknown <br /> if no, explain: <br /> Dcscribe Septic S.vstvm to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied b} PHN ate Well ? 0 Yes ❑ No Is well properly scaled and constructed ? Yes F� No <br /> Describe deficiency, if anti-: <br /> Is )%ell systema a Public Water-s,stem ? ❑ Yes El' 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 nater/Nvell sampling current ? ❑ Yes ❑ No <br /> Additional information or comments: <br /> 3. GAIZBAGF & RI?F11S1:: <br /> Licensed scaycr�hcr picl;-up'.' ❑ Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential Problcrn(s): <br /> -t. 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 011f.RATION 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 /> 1106 06 Report 47201 March 08.2010 <br />