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NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0012062 <br /> DATE RECEIVED by EHD: November 19,2018 APPL#: PA-1800292 <br /> Referral Agency STAFF CONTACT CHRISTINE LUCKASEN PE : 2631 <br /> SITE APPROVAL-MINOR(SA) <br /> COMPLETE&SUBMIT BY: Thu, December 20, 2018 <br /> Assigned to : EE0000034 ARMED <br /> SITE ADDRESS: 8853 S MANTHEY RD, FRENCH CAMP APN : 19320009 <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: ,wry <br /> Name of Purveyor Name of System <br /> SUMMARY OR COMMENTS: <br /> Z. Se'L horf�� per fit <br /> P'tIC v454 f7w~-j- <br /> "ll- llfs 6"fd- Y0Srt : U�eAPe -to ac.cceJt daft . Vnnble -to ytn`•f'� cm„el�y,,Y„ - 4- "-e-a- <br /> I recommend: Approval ❑ Denial El Continuance Inspector: N/6d.e.e.., <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> SUPERVISOR/LEAD SENIOR Approval: Date: ✓V <br /> 1 k ffList: Proofread Report? Correct LAND USF,#? <br /> Correct CONDITION(S)? Logged in LAND USE Book? - <br /> EH 06 06 Report#7201 November 20,2018 <br />