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NOTE- PULL ALL .RMITS (Septic, Well, etc.) MAKE _-MIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: 7a�� Connection Necessary ? Yes dNo <br /> Does Existing Septic System comply with San Joaquin County Development Title ? Q �es No 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 No Is PublicWater System Permit current ? Yes No <br /> Does existing or proposed use make this a P blic Water System ? Yes No <br /> Is water/well sampling current? 'es 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: ygy � <br /> 5. TOILET/ BATH FACILITIES: <br /> Number and Location(s)of existing facilities: <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> li:� <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 Repon#7201 Innuary 30.2009 <br />