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NOTE: PULL ALsRMITS (Septic, Well, etc.) MAKE,.,jPIES FOR FILE a. y <br /> 1. SEWAGE: <br /> Distance to Public Sewers: Connection Necessary? Yes 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? 'Yes No Is well properly sealed and constructed ?' Yes E] No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? ❑ Yes �o. Is Public Water System Permit current? Yes ❑ No <br /> Does existing or proposed use make this a Public Water System? ❑ Yes F-1 No <br /> Is water/well sampling current? ❑ Yes ❑ No <br /> Additional information or comments: <br /> 3. GARBAGE&REFUSE: <br /> Licensed scavenger pick-up? ❑ Yes 2-fio 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 /> S. TOILET 1 BATH FACILITIES: <br /> Number and Locatioq(s)of existing facilities: 422� <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> 7. GENERAL SANITATION: <br /> List any problem(s) not previously noted: <br /> k T <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> EH 06 06 Report#7201 March 07,2006 <br />