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NOTE: PULL AL ' RMITS (Septic, Well, etc.) MAKE�PIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0007935 <br /> DATE RECEIVED by EHD: September 28,2009 APPL#: PA-0900192 <br /> Referral Agency STAFF CONTACT: MO HATEF PE : 2622 <br /> SUBDIVISON-MINOR(MS) <br /> COMPLETE& SUBMIT BY: Tue, October 20, 2009 <br /> Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: 751 E FOREST LAKE RD,ACAMPO APN : 00313001 <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 /> Supervisor/Lead Senior COMMENTS: <br /> B <br /> n014 14 <br /> _ D Z <br /> � D <br /> SUPERVISOR/LEAD SENIOR Approval: - Date: Z 0 <br /> OA f1 Ghck Off L�sf� rurafread Repurt? Cbrreat LAt-ID USE# � '. <br /> w <br /> �' � Drrect O{ ND1Ti S ?Asowl irrLAND <br /> Eli 06 06 Report#7201 October 05,2009 <br />