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NOTE: PULL ALL RMITS (Septic, Well, etc.) MAKE _ )PIES FOR FILE <br /> i. SEWAGE: <br /> Distance to Public Sewers: - Connection Necessary? El Yes El No <br /> Does Existing Septic System comply with San Joaquin County Development Title ? F—] Yes E]-- No Unknown <br /> If no, explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? 0-Ves F-1No Is well properly sealed and constructed ? Q "Yes No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? F-� Yes Ej/No Is Public Water System Permit current ? F� I es No <br /> Does existing or proposed use make this a Public Water System ? F-1 Yes F] No <br /> Is water/well sampling current? F-1 Yes F-1 No <br /> Additional information or comments: <br /> 3. GARBAGE& REFUSE: <br /> Licensed scavenger pick-up9 eJI es F-1 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: j <br /> J1 06 06 Report 97201 October 20,2008 <br />