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NOTE: PULL ALL RMITS (Septic, Well, etc.) MAKE% PIES FOR FILE <br /> I. SEWAGE: _ <br /> Distance to Public Sewers: 7 aD4 Connection Necessary? 0 Yes [2'No <br /> Does Existing Septic System comply with San Joaquin County Development Title? F� Yes F-1 No QUnknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well? Q—V�es ❑ No Is well properly sealed and constructed? .jEj Yes 0 No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system? ❑ Yes Q-No Is Public Water System Permit current? F-1 Yes No <br /> Does existing or proposed use make this a Public Water System? F-1 Yes No <br /> Is water 1 well sampling current? ❑ Yes Ej No <br /> Additional information or comments: <br /> 3. GARBAGE&REFUSE: <br /> Licensed scavenger pick-up? lam` i es F-� No Service Area No. <br /> Other proposed disposal method: <br /> Potential Problem(s): <br /> 4. FLYLMOSQUITO OR VECTOR CONTROL: <br /> Describe potential Vector Control issues: <br /> 5. TOILET/BATH FACILITIES: <br /> Number and Location(s)of existing facilities: ��� �G/ <br /> Additional facilities required: <br /> 6. PREVJOUS 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 /> I <br /> EH 06 06 Report#7201 May 10,2010 <br /> I <br />