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NOTE: PULL ALL,.. RMITS (Septic, Well, etc.) MAKE SPIES FOR FILE <br /> LAND USE REPORT RECORD ID: S00004533 <br /> DATE RECEIVED by EHD: June 30,2004 APPL#: PA-04-354 <br /> Referral Agency STAFF CONTACT: GILLIAN HAYES PE : 2631 <br /> SITE APPROVAL-MINOR(SA) <br /> COMPLETE& SUBMIT BY: Wed, July 14, 2004 Assigned to : EE0005944 ESCOTTO <br /> SITE ADDRESS: 2547 N JACK TONE RD, STOCKTON APN : 02317008 <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 /> —Fs 6E AXIM - --f/0 res � r$nt� foZZ�tis sTi t � <br /> —Tif�f�/10��e31 f�LYZYi 4'1E l� As1>i27/J le 7crt��y)Fr7/ ir+L0�7Zdr�T PL. <br /> S-/S .SrZct47�9/.✓�-si�s�7'�-�f/_�Xf11i_/JlJL�11/1?/Jfii.✓��.��✓Zlf���ic�z1«'SI�tE� c� <br /> I recommend: Approval Denial Continuance Inspector: <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> t7 <br /> J <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> OA 11 Check Off List: Proofread Report? - Correct LAND USE#? <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> ETI 06 06 Report#7201 Page 9 1uk 07.2004 <br />