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NOTE: PULL All IIERMITS (Septic, Well, etc.) MAIC OPIES FOR FILE <br /> LAND USE REPORT — RECORD ID: SU0006925 <br /> DATE RECEIVED by EHD: January 25,2008 APPL 4: PA-0800012 <br /> Referral Agency STAFF CONTACT: PATRICK CROSBY PE : 2622 <br /> SUBDIVISON-MINOR(MS) <br /> COMPLETE&SUBMIT BY: Tue, February 19, 2008 <br /> Assigned to : EE0005366 MEDCNA <br /> SITE ADDRESS: 22105 N DUSTIN RD, ACAMPO APN : 01715046 <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 neap 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 /> . 0 <br /> %/. �3 i <br /> I recommend: Approval Denial Continuance ❑ Insp r <br /> 4Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> N zo 0 0 Z.. <br /> c+9 <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> 0,4�!Ch� c1*£Jff Cgr t- ND I3SR n <br /> . ... . m correct G1ITIOIr1( _W ...L�t1 Jn IANDl1 Buak`� <br /> EH 06 06 Report 97201 January 25,2008 <br />