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JH <br /> NOTE: PULL ALL PER1*fS (SEPTIC, WELL, ETC...) MICKE COPIES FOR FILE <br /> LAND USE REPORT APP#: PA-04-23 (MS) <br /> EHD RECEIVED APP.REFERRAL: 220/04 COMPLETE & SUBMIT BY: 3-02-04 <br /> DATE DATE <br /> ATTN: JENNIFER ILII 7 EY <br /> SITE ADDRESS: 33510 SOUTH KOSTER ROAD9 TRACY <br /> In completing the Land Use investigation, draw all Public Health factors on the exhibit(i.e.: sewage disposal, <br /> water supplies, etc...). Where necessary, on an attached piece of plain paper, draw a completed map of area <br /> showing population density, location of house, wind direction, etc.... <br /> Public water: A4� Public sewage: /1-1P" <br /> SUMMARY OR COMMENTS: <br /> � y <br /> l� ( /� ✓t .r t �i�t s�.�t r /� . .el D /rte .rZ <br /> 3)/S -D/ �¢Kc<n.o �� ez�^ ��/J �� '��ifi'' • ��c SSS <br /> 33(0d0 itCvGt- 44euE.I,� A4,01 /.e 2e�dzxg &,Mar A ca - <br /> I recommend: Approval ✓Denial Continuance Inspector's Signa retu r <br /> Supervisor/Lead Senior Comments: <br /> 0 <br /> 0 <br /> C a 2 :o Skc) �+00 �7 cQ c..a w 2� 3 3 6 oa <br /> 1A1.?1�J �.Jirvt�4.L�A/ O`�"^ <br /> �W? l <br /> Q S— a a <br /> :a 3 _ <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> EH 06 06 Rev 1/99 OA FT CHECK OFF LIST: _Proofread report? Correct LAND CASE#? <br /> Correct CONDITION(S)? _ Logged to LAND VSE BOOK? <br />