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NOTE: PULL ALL ,,.RMITS (Septic, Well, etc.) MAKE .PIES FOR FILE <br /> LAND USE REPORT RECORD ID: S00004572 <br /> DATE RECEIVED by EHD: July 20,2004 APPL#: PA-02-400 r6e <br /> Referral Agency STAFF CONTACT: 1 I/ r� PE : 2631 <br /> SITE APPROVAL-MINOR(SA) <br /> COMPLETE& SUBMIT BY: Tue, August 3, 2004 <br /> Assigned to : EE0005366 MEDINA <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 ❑ Continuance ❑ Inspector: <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> EH 06 06 Report#7201 Page 2 July 26,2004 <br />