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NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0011136 <br /> DATE RECEIVED by EHD: November 29,2016 APPL#: PA-1600253 <br /> Referral Agency STAFF CONTACT: JOHN FUNDERBURG PE : 2690 <br /> LOT LINE ADJUSTMENT(LA) <br /> COMPLETE&SUBMIT BY: '. 1 � � <br /> Fri r 44 Assigned to : EE0004045 TASIOPOULOS <br /> SITE ADDRESS: 21621 S MOUNTAIN HOUSE PKWY, MOUNTAIN APN : 20940526 <br /> kiUUNh <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 El Inspector: <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> SUPERVISOR/LEAD SENIOR Approval: Date: 2 <br /> OA 11 Check Off List: Proofread Report? Correct LAND USE 9? <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> EB 06 06 Report 97201 November 29.2016 <br />