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NOTE: PULL ALL RMITS (Septic, Well, etc.) MAKE,.,IPIES FOR FILE <br /> LAND USE REPORT RECORD 1D: SU0007078 <br /> DATE RECEIVED by EHD: March 21,2008 APPL#: PA-0800069 <br /> Referral Agency STAFF CONTACT: PATRICK CROSBY PE : 2622 <br /> SUBDIVISON-MINOR(MS) <br /> COMPLETE& SUBMIT BY: Tue, April 15, 2008 <br /> Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: 4777 W FOREST LAKE RD, ACAMPO APN : 00319004 <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: /Xyl Public Sewer: /Xy1P <br /> Name of Purveyor Name of System <br /> SUMMARY OR ! <br /> 04 -- <br /> Map/Certificate of Compliance <br /> ap/Certificate Of Compliance <br /> 14-03 (a)Soil Suitability Study <br /> X2:01 <br /> 22:03 4Add after"abandoned well"- "for the sealed well located on Parcel#3" <br /> NOT An�{of Service Well permit can be taken out at the EHD. The permit <br /> will need to be finaled prior to recordation of Final Map/Certificate of <br /> Compliance. The fee for the permit is $100.00�,�� <br /> 11:11 (b) Report Dated November 19, 2007-Prior to map/Certificate of Co <br /> 200:02 add after for—"additional living structures" chance <br /> u8etv—or `" d Siffif6k <br /> OU <br /> o(ePM G! <br /> C.� -z: SL <br /> if I 2 U 3 S40fl71- <br /> Ivt S7G <br /> SCPFRN''ISOR / LEAD SENIOR Approval: <br /> OA II Check ON List: Proofhad,Report? Correct LAND GSL'ft? <br /> Correct CONDI r(QN(S)'? Larged m LAND USI:Book`.' <br /> EH 06 06 Report 97201 �.!.. '...206A <br />