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POEM <br /> NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0011567 <br /> DATE RECEIVED by EHD: November 03,2017 APPL#: PA-1700251 <br /> Referral Agency STAFF CONTACT GIUSEPPE SANFILIPPO PE : 2622 <br /> SUBDIVISON-MINOR(MS) <br /> COMPLETE&SUBMIT BY: Mon, November 13, 2017 <br /> Assigned to : EE0009488 WONG <br /> SITE ADDRESS: 21379 N MANN RD,ACAMPO APN : 01728009 <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 /> SUMMARY OR COMMENTS: <br /> Name of Purveyor Name of System r <br /> _ l l� CG( 6A ? <br /> LJ D U e o1 a lfi <br /> Z ` JAX i d <br /> a' W LE o rr til D O 2 -... -5 P D -S Ill kS <br /> 11 n U S-p c1 'f C e'6 <br /> rD`vcti <br /> L <br /> I reco mend: Approval ® DenialEl Continuance El Inspector: <br /> gnature <br /> Supervisor/Lead Senior COMMENTS: <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> OA 11 Check Off List: Proofread Report? Correct LAND USE#? <br /> Correct CONDITION(S)? Logged in LAPID USE Book? <br /> EH 06 06 Rcpon T7201 November 06,2017 <br />