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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: — 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 />OA II Check 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 />