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NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> LAND USE REPORT RECORD H): S00011276 <br /> DATE RECEIVED by EHD: March 20,2017 APPL#: PA-1700047 <br /> Referral Agency STAFF CONTACT: JOHN FUNDERBURG PE : 2632 <br /> SITE APPROVAL-GENERAL(SA) <br /> COMPLETE& SUBMIT BY: Tue, April 4, 2077 <br /> Assigned to : EE0004045 TASIOPOULOS <br /> SITE ADDRESS: MOUNTAIN HOUSE PKWY, MOUNTAIN HOUSE APN: 25403001 <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: J— 4 2 Public Sewer: <br /> Name ofPurveyor Name of System <br /> SUMMARY OR COMMENTS: <br /> r <br /> I recommend: Approval Denial Continuance Inspectorl� -- <br /> i r'----519nature <br /> Supervisor/Lead Senior COMMENTS: <br /> id <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> A II Ch,,k Off List: Proofread Report? Correct LAND USE# <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> EH 06 06 Report#7201 March 23,2017 <br />