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NOTE: PULL ALL%,,,IMITS (Septic, Well, etc.) MAKE ,.,j;PIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: r Connection Necessary ? Er Yes Er No <br /> Does Existing Septic System comply with San Joaquin County Development Title? ❑ Yes F] No Unknown <br /> If no,explain: <br /> Describe Septic System to he installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? F] Yes [D-No Is well properly sealed and constructed ? F] Yes [—] No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? ED--Yes F� No Is Public Water System Permit current? E] Yes F No <br /> Does existing or proposed use make this a Public Water System ? [] Yes ❑ No <br /> Is water/well sampling current? ❑ Yes E] No <br /> Additional information or comments: <br /> 3. GARBAGE&REFUSE: <br /> Licensed scavenger pick-up? M Yes 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: Z21:2f <br /> i <br /> 5. TOILET/BATH FACILITIES: <br /> Number and Location(s)of existing facilities: irz�ii ( a <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> 7. GENERAL SANITATION: <br /> List any problem(s) not previousIy noted: t( <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br />'1-106 06 Report#7201 September 06,2007 <br />