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i <br /> i <br /> NOTE; PULL ALL PERMITS (Septic, Well, etc.)'MAKE COPIES FOR FILE <br /> LAND USE REPORT RECORD 1D: SU0410612 <br /> DATE RECEIVED by EHD: August 25,2015 APPL#: PA-1500148 <br /> Referral Agency STAFF CONTACT: JOHN FUNDERBURG PE : 2688 <br /> SPECIAL LAND USE PROJECT(PR) <br /> COMPLETE& SUBMIT BY: Mon, September-14, 2015 <br /> Assigned to :.EE01.004045 TASIOPOULOS <br /> SITE ADDRESS: 19629 S MOUNTAIN HOUSE PKWY, MOUNTAIN APN : 20904018 <br /> IMUSE <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 Inspecto _ <br />+ t El ❑ ' Si t re <br />'. Supervisor/Lead Senior COMMENTS- <br /> SUPERVISOR/LEAD SENIOR Approval: Date:O <br /> A!! h Li Proofread Report? ,Correct LAND USE#? ` r <br /> Correat.CpNDITION(S} in-LAND USE Book? <br /> EH 06 06 Report#7261 August 27,2015 <br /> S <br />