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NOTE: PULL AL4,, RMITS (Septic, Well, etc.) MAKE�,jJPIES FOR FILE ' <br /> I. SEWAGE: <br /> _ .. ...—.._. <br /> Distance to Public Sewers: Connection Necessary ? ❑ Yes O-No <br /> Does Existing Septic System comply with San Joaquin County Development Title? Yes No Unknown <br /> If no, explain- <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? E j— es ❑ No Is well properly sealed and constructed ? —Yes [:] No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? 0 Yes E]'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 water/well sampling current? E] Yes M No <br /> Additional information or comments: <br /> 3• GARBAGE&REFUSE: <br /> Licensed scavenger pick-up? --Yes No Service Area No. <br /> Other proposed disposal method: <br /> PotentialProblem(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#7241 January 25,2008 <br />