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NOTE: PULL ALt..21RMITS (Septic, Well, etc.) MAK PIES FOR FILE <br /> LAND USE kEPORT RECORD ID: SU0007960 <br /> DATE RECEIVED by EHD: October 23,2009 APPL#-" PA-0400479 REV SITE PLN , <br /> Referral Agency STAFF CONTACT: JOHN FUNDERBURG PE : 2631 <br /> SITE APPROVAL-MINOR(SA) <br /> COMPLETE& SUBMIT BY: Tue, November 17, 2009 <br /> Assigned to : EE0445366 MEBINA <br /> SITE ADDRESS: 120 W ACAMPO RD, ACAMPO APN : 01.312065 <br /> In completing the Land Use investigation, draw all Public Health factors on the exhibit(i.e., sewage disposal, water <br /> supplies, etc...). Where necessary, on an attached piece of plain paper, draw complete map of area showing population <br /> density, location of house, wind direction, etc.... <br /> Public Water: Public Sewer: <br /> Name of Purveyor Name of System <br /> SUMMARY OR COMMENTS!/ <br /> I recommend: Approval Denial Continuance ❑ i r. <br /> ignature <br /> Supervisor/Lead Senior COMMENTS: <br /> SUPERVISOR/LEAD SENIOR Approval: Date: v (� <br /> OA <br /> 117& aff List 1'roQfe�Repart eec �Nf?CI �Y7wwl <br /> _ <br /> 0rrecti91TILI�{(S) �_ Lo ecI izANI �f3 lc� <br /> EH 06 06 Report 47201 <br /> October 27,2009 <br />