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NOTE: PULL AL .:RMIT3 (Septic, Well, etc.) MAKE, PIES FOR FILE i <br /> 1. SEWAGE- <br /> Distance to Public Sewers: C Connection Necessary ? ❑ "Yes N �4k4 <br /> Does Existing Septic System comply with San Joaquin County Development Title? ��'es ❑ No Unknown <br /> If no, explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well? es ❑ No Is well properly sealed and constructed ? ❑ Yes E] No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system? as E] No Is Public Water System Permit current? �Yes ❑ No <br /> Does existing or proposed use make this Public Water System? ❑ Yes ❑ No <br /> Is water/well sampling current? ❑ Yes ❑ No <br /> Additional information or comments: <br /> 3. GARBAGE &REFUSE: <br /> Licensed scavenger pick-up? ❑�s ❑ 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 1 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 /> F if 06 06 Report 47201 November 25,2008 <br />