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r <br /> i <br /> NOTE: PULL ALL'PERMITS (Septic, Well, etc.) MAKE CAIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: Connection Necessary? ❑ Yes ❑ No <br /> Does Existing Septic System comply with San Joaquin County Development Title? ❑ Yes No E] Unknown <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well ? F] Yes [—] No Is well properly sealed and constructed ? Yes No <br /> Describe deficiency, if any: <br /> Is well system a Public Water system? 7 Yes ❑ No Is 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? Q Yes ❑ No <br /> Additional information or comments: <br /> 3. GARBAGE&REFUSE: <br /> Licensed scavenger pick-up? ❑ Yes F-1 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 /> I <br /> r <br /> 5. TOILET I 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 47201 <br /> August 31,2010 <br />