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NOTE: PULL ALL l*w.tMITS (Septic, Well, etc.) MAKE MES FOR FILE <br /> L SEWAGE: <br /> Distance to Public Sewers ;��,L� � Connection Necessary ? ❑ Yes No <br /> Does Existing Septic System comply with San Joaquin County Development Title ? Yes No Unknown <br /> [[no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? ❑ Yes No Is well properly sealed and constructed ? ❑ Yes ❑ No <br /> Describe deficiency,if any. <br /> Is well system a Public Water system ? Yes ❑ No Is Public Water System Permit current ? ❑ Yes E No <br /> Does existing or proposed use make this a Public Water System ? ❑ Yes 7 No <br /> Is water/well sampling current ? 7 Yes No <br /> Additional information or comments: <br /> 3. GARBAGE& REFUSE: <br /> Licensed scavenger pick-up? es 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. t�E,✓ <br /> L <br /> 7. GENERAL SANITATION: <br /> List any problem(s) not previously noted: <br /> 8. POPULATION DENSITY.- <br /> Approximate <br /> ENSITY:Approximate number of people per square mile: _ , z2k / r._, <br /> Eli 06 06 Repot#7201 August 16,2006 <br />