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NOTE: PULL ALL .RMITS (Septic, Well, etc.) MAKE . _PIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: N�- Connection Necessary ? F-1Yes © No <br /> Does Existing Septic System comply with San Joaquin County Development Title ? aVes ❑ No F-1 Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? Q'Yes E] No Is well properly sealed and constructed ? aYes ❑ No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? ❑ Yes E No Is Public Water Sys em Permit current ? F-1Yes F-1No <br /> Does existing or proposed use make this a Public Water System ? F-1Yes No <br /> Is water/well sampling current ? ❑ Yes ❑ No <br /> Additional information or comments: <br /> 3. GARBAGE& REFUSE: <br /> Licensed scavenger pick-up? ❑ Yes 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 /> r <br /> 5. TOILET/BATH FACILITIES: <br /> Number and Location(s)of existing facilities: <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> ��C �yr✓ <br /> 7. GENERAL SANITATION: <br /> List any problem(s) not previously noted: <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: �fJL�/L.�Lci �jvZtj <br /> EH 06 06 Report 07201 January 30,2007 <br />