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NOTE: PULL ALL\- RMITS (Septic, Well, etc.) MAKEI4PIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0004990 <br /> DATE RECEIVED by EHD: April 12,2005 APPL#: QX-80-0001 <br /> Referral Agency STAFF CONTACT: KATHY ALLEN PE : 2605 <br /> EXCAVATION-QUARRY(QX) <br /> COMPLETE& SUBMIT BY: Wed, May 4, 2005 <br /> Assigned to : EE0000149 BORGES <br /> SITE ADDRESS: 30350 S MAC ARTHUR DR,TRACY APN : 25313002-3,& <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 /> Aa. S# ,/Kw Agetz� 2'K <br /> SUPERVISOR/ LEAD SENIOR Approval: Date: . <br /> OA It Check OH List Proofread Report? Correct LAND USE#? <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> Eli 06 06 Repon 97201 Page 2 April 13,2005 <br />