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NOTE: PULL ALL IMITS (Septic, Well, etc.) MAKE UPIES FOR FILE <br /> 1. SEWAGE: <br /> Distance to Public Sewers: ZIO Connection Necessary? 2 Yes ❑ No <br /> Does Existing Septic System comply with San Joaquin County Development Title? ❑ Yes ❑ No E3"ITAR""n <br /> If no,explain: <br /> Describe Septic System to be installed: <br /> 2. WATER SUPPLY: <br /> Is Water supplied by Private Well? 0 Yes [2"No Is well properly sealed and constructed ? F� Yes F� No <br /> Describe deficiency,if any: <br /> Is well system a Public Water system ? 0 Yes [—] No Is Public Water System Permit current? F] Yes F—] No <br /> Does existing or proposed use make this a Public Water System ? F� Yes [--j No <br /> Is water/well sampling current? F-1 Yes F-� 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: Qc'i f�3fC <br /> Additional facilities required: <br /> 6. PREVIOUS OPERATION HISTORY: <br /> 7. GENERAL SANITATION: <br /> List any problem(s) not previously noted: L� /u/c7Gr GrS 5� 7�Z2t� �s <br /> 8. POPULATION DENSITY: <br /> Approximate number of people per square mile: Qjyjf� <br /> :H 06 06 Report#7201 February 02,2007 <br />