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NOTE: PULL ALL PERMrTS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP#: PA-03-679 QPD Rev.Project Desc. <br /> EHD RECEIVED APP.REFERRAL: 213104 COMPLETE & SUBMIT BY: 2�1 k 2004 <br /> DATE DATE <br /> ATTN: JENNIFER JOLLEY <br /> SITE ADDRESS: Eastern fork of Koster,South of Blewett,East of Delta Mendota Canal,South of Tracy <br /> In completing the Land Use investigation, draw all Public Health factors on the exhibit (i.e.: sewage disposal, <br /> water supplies, etc...). Where necessary, on an attached piece of plain paper, draw a completed map of area <br /> showing population density, location of house, wind direction, etc.... <br /> Public water: Public sewage: <br /> SUMMARY OR COMMENTS: <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> EH 06 06 Rev 11'99 <br /> 8. <br />