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NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0009458 <br /> DATE RECEIVED by EHD: December 21,2012 APPL#: PA-1200252 <br /> Referral Agency STAFF CONTACT: CORINNE KING PE : 2690 <br /> COMPLETE&SUBMIT BY: LOT LINE ADJUSTMENT(LA) <br /> . Assigned to: EE0004045 TASIOPOULOS <br /> SITE ADDRESS: MOUNTAIN HOUSE PKWY,MOUNTAIN HOUSE APN: 25637005 07 08 09 10 13 14 15 <br /> 116 111F is 119 23 24 25 <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 /> ame of Purveyor Name of System <br /> SUMMARY ORCOMMEN S: �L 12,7 /1Z Z,;;,4 <br /> z�6 <br /> 1 recommend: Approval �_ Denial El Continuance El Inspector <br /> S' re <br /> Supervisor/Lead Senior COMMENTS: <br /> ISI <br /> z <br /> SUPERVISOR/LEAD SENIOR Approval: �� — - -_� �= Date: <br /> OA it Check Off List: Proofread Report? >.__. Correct LAND USE <br /> Correct CONDITION(S)? Lugged in LAND USE Book? <br /> EH 06 06 Report#7201 <br /> December 26,2012 <br />