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NOTE: PULL ALL l�RMITS (Septic, Well, etc.) MAKE C IES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: 7 Connection Necessary? ❑ Yes ❑ No <br /> Does Existing Septic System comply with San Joaquin County Development Title? ❑ Yes ❑ No ❑ Unmown <br /> If no,explain: ) <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? ayes E] No Is well properly sealed and constructed ? Yes ❑ No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? ❑ Yes © 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? ❑ Yes ❑ No <br /> Additional information or comments: <br /> 3. GARBAGE&REFUSE: <br /> Licensed scavenger pick-up? 0 Yes ❑ No Service Area No. <br /> Other proposed disposal method: <br /> Potential Problem(s): <br /> 4. FLY MOS UITO OR VECTOR CONTROL: <br /> Describe potential Vector Control issues. <br /> k <br /> 5. TOILET/BATH FACILITIES: <br /> Number and Location(s)of existing facilities: <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> i <br /> t 7. GENERAL SANITATION: <br /> List any problem(s)not previously noted: <br /> 8. POPULATION DENSITY: <br /> i <br /> Approximate number of people per square mile: e <br /> March 22,2010 <br /> ;H 06 06 Report 47201 <br />