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NOTE: PULL ALL� RMITS (Septic, Well, etc.) MAKE�IPIES FOR FILE <br /> LAND USE REPORT RECORD : SU0007967 <br /> DATE RECEIVED by EHD: November 02,2009 ADPL#: PA-0900261 <br /> Referral Agency STAFF CONTACT: MO HATEF PE : 2690 1 <br /> COMPLETE& SUBMIT BY::A& <br /> LOT LINE ADJUSTMENT(LA) <br /> .. <br /> Assigned to : EE0004045 TASIOPOULOS <br /> SITE ADDRESS: 23210 S KASSON RD, TRACY APN : 23906013 14 <br /> I. <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 P rveyor Name of System <br /> SUMMARY OR COMMENTS: 11 7 <br /> A14 6 <br /> .l <br /> l <br /> I recommend: Approval ® Denial Continuance Inspector 1" <br /> gnature <br /> Su ervisor/Lead Senior COMMENTS: S <br /> I <br /> a <br /> I <br /> { <br /> SUPERVISOR/LEAD SENIOR Approval: mate: D <br /> (1A i!Check Off LYst Prot�lzeadRprt _ srrect LAND LL # 7-7 <br /> orreat UC)NDTI IO (S L ged`n LAID USE 13ook <br /> EH 06 06 Report#7201 <br /> November 03,2009 <br />