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NOTE: PULL ALI,` .RMITS (Septic, Well, etc.) MAKE )PIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: _ Connection Necessary? F-1 Yes F-1 No <br /> Does Existing Septic System comply with San Joaquin County Development Title? F1 Yes r_1 No r_1 Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? F� Yes F-1 No Is well properly sealed and constructed ? F-] Yes No <br /> Describe deficiency, if any: <br /> Is well system a Public Water system ? F-1 Yes F-] No Is Public Water System Permit current ? Yes No <br /> Does existing or proposed use make this a Public Water System ? 7 Yes F� No <br /> Is water/well sampling current ? F_� Yes F-] No <br /> Additional information or comments: <br /> 3. GARBAGE & REFUSE: <br /> Licensed scavenger pick-up? F-1 Yes r—] 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 /> 7. GENERAL SANITATION: <br /> List any problem(s) not previously noted <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile <br /> EH 06 06 Report#7201 page 2 June 21.2004 <br />