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( NOTE: PULL AL`-.jERMITS (Septic, Well, etc.) MAKE ..0PIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: c7C �J Connection Necessary? E] Yes No <br /> Does Existing Septic System comply with San Joaquin County Development Title? E] 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? ID—Ye—s F] 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 Public Water System Permit current '? 0 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? 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 /> 5. TOILET/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: Z2� <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: �- <br /> EH 06 06 Report 47201 August 26,2005 <br />