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NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0012411 <br /> DATE RECEIVED by EHD: July 15,2019 APPL 4. PA-1700093 <br /> Referral Agency STAFF CONTACT: ALISA GOULART PE : 2631 <br /> SITE APPROVAL-MINOR(SA) <br /> COMPLETE&SUBMIT BY: Thu, August 8, 2019 <br /> Assigned to: EE0007380 SIIIH <br /> SITE ADDRESS: 21025 S CARROLTON RD, RIPON APN: 24522002 <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 Inspector: <br /> Signature <br /> Suoervisor/Lead Senior COMMENTS: <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> A 11 h k ff List, Proofread Report? Correct LAND USE#9 <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> EH 06 06 Report#7201 July 16,2019 <br />