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NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE'QOMES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0004739 <br /> DATE RECEIVED by EHD: November 30,2004 APPL#: PA-04-702 <br /> Referral Agency STAFF CONTACT: RICK GRIFFIN PE : 2631 <br /> SITE APPROVAL-MINOR(SA) <br /> COMPLETE&SUBMIT BY: Tue, December 21, 2004 <br /> Assigned to : EE0009649 ESTRADA <br /> SITE ADDRESS: 4124 E MARIPOSA RD, STOCKTON APN: 17908219 <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 F-1 Inspector: <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> 0N/ 11,01 <br /> a. Aw tiny N <br /> e <br /> 7� i,{�a• o� <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> OA II Check Off List: Proofread Report? Correct LAND USE#? <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> EH 06 06 Report#7201 Page 5 ,O �.�rL d e/C �„ December 13,2004 <br /> I I a fz1004? <br />