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f <br /> NOTE: PULL ALL%..,RMITS (Septic, Well, etc.) MAKE PIES FOR FILE t <br /> 1. SEWAGE: <br /> Distance to Public Sewers: Connection Necessary? ❑ Yes F-1 No <br /> Does Existing Septic System comply with San Joaquin County Development Title ? ❑ Yes ❑ No r-1 Unknown f <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> E <br /> { <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? ❑ Yes F] No Is well properly scaled and constructed ? Yes No <br /> Describe deficiency, if any: <br /> Is well system a Public Water system ? F-1 Yes F-] No Is Public Water System Permit current ? E] Yes 0 No <br /> Does existing or proposed use make this a Public Water System ? F-] Yes No <br /> 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: <br /> S. TOILET/BATH FACILITIES: <br /> Number and Location(s)of existing facilities: <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> ji <br /> 7. GENERAL SANITATION: I <br /> f <br /> List any problem(s) not previously noted: f <br /> S. POPULATION DENSITY: <br /> Approximate number of people per square mile: <br /> E <br /> H 06 06 Report#7201 November 15,2007 � <br />