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�. <br /> NOTE: PULL ALLY ,- JRMITS (Septic, Well, etc.) MAKE ...iP1ES FOR FILE <br /> RECORD ID: SU0004697 <br /> LAND USE REPORT <br /> APPL#: QX-94-01 (RA) <br /> DATE RECEIVED by EHD: November 15,2004 <br /> PE : 2656 <br /> Referral Agency STAFF CONTACT: KEVIN SWANSON REVISIONS TO ACTIONS-STAFF <br /> REVIEW APPI.(SR) <br /> COMPLETE& SUBMIT BY: Wed, December 1, 2004 Assigned to : EE0000149 BORGES <br /> APN -. 26512006,16,& <br /> SITE ADDRESS: 37282 S BIRD RD,TRACY <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 System <br /> Name of Purveyor <br /> SUMMARY OR COMMENTS: <br /> k <br /> I recommend: Approval Denial Continuance E] Inspector: Signature <br /> Su e -visor/Lead Sensor COMMENTS: <br /> 0111 <br /> v7k7f <br /> SUPERVISOR/LEAD SENIOR Approval: <br /> Date: <br /> I o a edon tiANDNI�LJS <br /> DA 1!Check Off Lis#: Prciofreac!Retirt? E,#? <br /> ©rrect"COND.1tiO�..(§)7 8 E Book? <br /> EH 06 06 Report X7201 <br /> Page 3 November 16,2004 <br />