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NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0009143 <br /> DATE RECEIVED by EHD: April 06,2012 APPL#: PA-0400479 TE <br /> Referral Agency STAFF CONTACT: JOHN FUNDERBURG PE : 2631 <br /> SITE APPROVAL-MINOR(SA) <br /> COMPLETE&SUBMIT BY: Tue, May 8, 2012 <br /> Assigned to: EE0005944 ESCOTTO <br /> SITE ADDRESS: 120 W ACAMPO RD, ACAMPO APN:®(3. 12c-&-5- <br /> In <br /> 2c-&,SIn 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 Inspector: <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: { <br /> SUPERVISOR/ LEAD SENIOR Approval: Date: <br /> OA 11 Check ON List: Proofread Report? Correct LAND USE#'? <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> -it 06 06 Report#7201 April 06,2012 <br />