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b <br /> NOTE; PULL. AL ERMITS {Septic, Well. etc.) MAK OPIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: Connection Necessary? IDYes y__I�No <br /> l <br /> Does Existing Septic System comply with San Joaquin County Development Title ? Yes No <br /> Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? Yes No Is well properly sealed and constructed ? Yes No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? ❑ Yes [!J No Is Public Water System Permit current ? Yes No <br /> Does existing or proposed use make this a Public Water System ? Yes No <br /> El Is water/well sampling current? F ] Yes ❑ No <br /> Additional information or comments: <br /> 3. GARBAGE &REFUSE: <br /> Licensed scavenger pick-up? 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: l <br /> 5. TOILET/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 /> EH 06 06 Report#7201 <br /> September 08,2005 <br />