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NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0004921 <br /> DATE RECEIVED by ERD: May 03,2005 APPL#: PA-0200400 <br /> Referral Agency STAFF CONTACT: RICK GRIFFIN PE : 2631 <br /> SITE APPROVAL-MINOR(SA) <br /> COMPLETE&SUBMIT BY: Tue, May 17, 2005 <br /> Assigned to: EE0000149 BORGES <br /> SITE ADDRESS: 8355 S MANTHEY RD,FRENCH CAMP APN: 19317028 <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 El Continuance ❑ Inspector: <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> OA II Check OH List Proofread Report? � V Correct LAND USE#? <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> EH 06 06 Report#7201 May 09,2005 <br />