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1. SEWAGE: NOTE: PULL ALL .RMITS (Septic, Well, etc.) MAKE �--JPIES FOR FILE <br /> Distance to Public Sewers: Connection Necessary? ❑ Yes No <br /> Does Existing Septic System comply with San Joaquin County Development Title ? r-,-' Yes No Q Unknown <br /> If 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 [j No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? Yes E] No Is Public Water System Permit current? Yes No <br /> Does existing or proposed use make this a Public Water System ? F-1 Yes No <br /> I;water/well sampling current ? ' 0 Yes No <br /> Additional information or comments: <br /> 3. GARBAGE&REFUSE: <br /> Licensed scavenger pick-up? E] 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: <br /> 5. TOILET/BATH FACILITIES: <br /> Number and Location(s)of existing facilities: <br /> Additional facilities required: <br /> h• PREVIOUS OPERATION HISTORY: <br /> 7. GENERAL SANITATION: <br /> List any problem(s)not previously noted: <br /> 1. POPULATION DENSITY: <br /> Approximate number of people per square mile: ` <br /> 06 06 Report#7201 <br /> May 23,2006 <br />