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NOTE: PULL ALL%_.RMITS (Septic, Well, etc.) MAKE`,PIES FOR FILE' <br /> LAND USE REPORT RECORD ID: SU0004504 <br /> DATE RECEIVED by EHD: June 09,2004 APPL#: PA-04-301 <br /> Referral Agency STAFF CONTACT: LEANNE MUELLER PE : 2622 <br /> SUBDIVISON-MINOR(MS) <br /> COMPLETE&SUBMIT BY: Tue, July 6, 2004 Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: 23800 N JACK TONE RD, ACAMPO APN : 02105090 <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: /ha <br /> Name of Purveyor Name of System <br /> SUMMARY OR COMMENTS: <br /> �y <br /> C) _ <br /> o J <br /> �J <br /> I recommend: Approval Denial F] Continuance Insp <br /> ignature " <br /> Supervisor/Lead Senior COMMENTS: <br /> Q <br /> / a <br /> 6 d 6 <br /> C. ate:a ,/ ✓ <br /> F- : o <br /> SUPERVISOR/LEAD SENIOR Approval: Date: / <br /> j " . Proofread Report?. <br /> 0.4''li Check Off List. - .' --... .. ° Gotrect LAND USE#.7 <br /> Correet. CONDITION{S ? Lagged in LAND ITSE Book?? <br /> . r)a. <br /> EH 06 06 Report 47201 Page 2 June 21,2004 <br />