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NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> LAND USE REPORT RECORD ED: SU0012013 <br /> DATE RECEIVED by EHD: December 19,2018 APPL#: PA-1000267 <br /> Referral Agency STAFF CONTACT JOHN FUNDERBURG PE : 2656 <br /> REVISIONS TO ACTIONS (RA) <br /> COMPLETE&SUBMIT BY: Wed, January 3, 2018 <br /> Assigned to : EE0000034 AHMED <br /> SITE ADDRESS: 17590 S KELSO RD,MOUNTAIN HOUSE APN: 25803001 <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: Nllesp <br /> Name of Purveyor Name of System <br /> SUMMARY OR COMMENTS: <br /> ' OcgK"(• j �qu % avej &Qpi>I`_ a l& frel teem0s. <br /> //!/3 at <br /> #!4 <br /> 77:03 <br /> I recommend: Approval El Denial El Continuance El Inspector: ss, )¢ <br /> Signature <br /> Suoervisor/Lead Senior COMMENTS: <br /> (Z Z e <br /> t <br /> l <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> OA/1 Proofread Report? Correct LAND USE#? <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> EH 06 06 Report#7201 December 21,2018 <br />