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NOTE: PULL ALLa _.RMITS (Septic, Well, etc.) MAKE _�jPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0004721 <br /> DATE RECEIVED by EHD: November 23,2004 ADPL#: PA-04-643 <br /> Referral Agency STAFF CONTACT: GILLIAN HAYES PE : 2631 <br /> SITE APPROVAL.-MINOR(SA) <br /> COMPLETE& SUBMIT BY: Tue, December 7, 2004 <br /> Assigned to : EE0005944 ESCOTTO <br /> SITE ADDRESS: 4426 E ST RT S$ HWY, STOCKTON APN : 10102158 <br /> In completing the Land Use investigation, draw all Public Health factors on the exp hibit(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 S6wer: <br /> Name of Purveyor Name of System <br /> SUMMARY OR COMMENTS: <br /> Z ,cam vr�L � <br /> I recommend: Approval Denial Continuance F-� Inspector: <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> r l <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> OA li Check Off List: <br /> ....Proofread Report? Gorreot LAND 17SE.#? <br /> Correct CONDITION(S)? Lugged in LAND USE Book? <br /> EH 06 06 Report#7201 Page 7 November 24,2004 <br />