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NOTE: PULL ALL*ERMITS (Septic, Well, etc.) MAKIl"06PIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: Connection Necessary? ❑ Yes F—] No <br /> Does Existing Septic Systeyn comply with San Joaquin County.Development Title ? ❑ Yes E] No Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? L] Yes ❑ No Is well properly sealed and constructed ? 0 `Yes ❑ No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? 0 Yes E] 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? F-1 Yes F--j No Service Area No. : <br /> Other proposed disposal method: <br /> Potential Problem(s): <br /> i <br /> 4. FLY,MOSQUITO OR VECTOR CONTROL: <br /> Describe potential Vector Control issues: <br /> f <br /> 5. TOILET/BATH FACILITIES: <br /> Number and Location(s)of existing facilities: i <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> 7, GENERAL SANITATION: <br /> List any problem(s)not previously noted: 1 <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> EH 06 06 Report 47201 <br /> June 20,2008 <br />