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NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0009459 <br /> DATE RECEIVED by EIID: December 21,2012 APPL#: PA-1200253 <br /> Referral Agency STAFF CONTACT: CORINNE E KING PE : 2690 <br /> a 0\/. LOT LINE ADJUSTMENT(LA) <br /> ASA <br /> COMPLETE&SUBMIT BY:J <br /> ASr Assigned to : EE0004045 TASIOPOULOS <br /> SITE ADDRESS: MOUNTAIN HOUSE PKWY, MOUNTAIN HOUSE APN: 25637005 07 08 091013 14 15 <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: `J!i> <br /> Name of Purveyor Name of System <br /> SUMMARY OR COMMENTS y <br /> I recommend: Approval Denial Continuance Inspecto <br /> re <br /> Supervisor/Lead Senior COMMENTS: <br /> 5' <br /> SUPERVISOR/ LEAD SENIOR Approval: -- _ Date: ( Z z r , <br /> OA//Check Off List: Proofread Report? - Correct LAND USE# <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> EH 06 06 Report 47201 December 26,2012 <br />