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NOTE: PULL ALk. _,ERMITS (Septic, Well, etc.) MAKE OPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SUOOGSS-2 <br /> DATE RECEIVED by Lill): August O5,2011 APPL#: PA-1100136 <br /> Referral Agency STAFF CONTACT: RICK GRIFFIN PE : 2611 <br /> SUBDIVISION-MAJOR(5L`) <br /> COMPLETE, & SUBMIT BY: Wed, August 31, 2011 <br /> Assigned to : EL0004W T:151C)POL'LOS <br /> SITE ADDRESS: 34770 S KOSTER RD, TRACY APN : 25517001 <br /> In corzlpletin�= the 1-and U.Se investigation. draw all Pttblic Health factors on the exhibit (i.e., sexvage disposal, kv ater <br /> �uppl ics_ etc...). % here neccssary, on an attached piece of plain paper. draw complete neap of area showing popUlation <br /> _lentiii� location of house. «vied direction. etc.... <br /> Public Vda.ter: Public Suver: <br /> Name of Purveyor NainQ of System <br /> SUN1N1AR1` 0R COMMENTS: <br /> %': <br /> , <br /> r # <br /> r,.r s� <br /> 741 <br /> s e <br /> n <br /> t <br /> t I J 4 .r . <br /> 1 recomnncnd: ApprovalF Y1 Denial F1Denial � Inspector; <br /> Signature <br /> 'uUjXrV iSM Lead Senior COMMENTS: <br /> C, 1 { <br /> ZILJ <br /> r ajll <br /> IJ <br /> SLAIERVISOR LEAD SENIOR A Provil: ...... -.. ___.. � <br /> ' 'Date: <br /> OA <br /> I , <br /> 11 Check Off List: Proofread Report? Correct LAND USE#?:: <br /> Correct CONDMOI ,'(S)? .. Logged.in I,AND USE:Boo)`? <br /> J1 E!r, A,Reporl�—r l <br />