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w <br /> NOTE: PULL ALLt .XMITS (Septic, Well, etc.) MAKE PIES FOR FILE <br /> I. SEWAGE: <br /> Distance to Public Sewers: -,;7" '7 Connection Necessary ? ❑ Yes E]�"No <br /> Does Existing Septic System comply with San Joaquin County Development Title? Yes No ©'Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? 2—'Yes ❑ No Is well properly scaled and constructed ? E]`Yes No <br /> Describe deficiency, if any: <br /> Is well system a Public Water system ? , Yes E3-5'N��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? F-1 Yes ❑ No <br /> Additional information or comments: <br /> 3. GARBAGE&REFUSE: <br /> Licensed scavenger pick-up? ET-Ves ❑ No Service Area No. <br /> Other proposed disposal method: <br /> Potential Problem(s): <br /> 4. FLY, MOSQUITO OR VECTOR CONTROL: E <br /> Describe potential Vector Control issues: <br /> i <br /> 5. TOILET/BATH FACILITIES: <br /> Number and Location(s)of existing facilities: <br /> i <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> 1 <br /> 7. GENERAL SANITATION: <br /> List any problem(s) not previously noted: { <br /> 8. POPULATION DENSITY; <br /> Approximate number of people per square mile: 1 <br /> t <br />-H 06 06 Report 47201 October 25,2007 <br />