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t\ )� <br /> RB <br /> NOTE: PULL ALL PERMS (SEPTIC, WELL, ETC...) NIS COPIES FOR FILE <br /> LAND USE REPORT APP#: PA-03-550 (QX) <br /> EHD RECEIVED APP.REFERRAL: 3/10/04 COMPLETE & SUBMIT BY: 4-07-04 <br /> DATE DATE <br /> ATTN: JENNIFER JOLLEY <br /> SITE ADDRESS: 35775 SOUTH KOSTER ROAD, 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: Public sewage: <br /> SUMMARY OR COMMENTS: <br /> 04. .• <br /> e,s'1tt�f/NA <br /> I re ommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> C <br /> y-r <br /> ��iV'ti 1 <br /> �aY . <br /> - : o / 1q. <br /> Cc * .b. �~ �" A <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> jb <br /> "bq� CHECK OFF LIST: _ Proofread report? Correct LAND USE#? <br /> EH 0606 Rev 1/99 �. ��,Q CorrectCONDMON(S)? Logged in LAND USE BOOK? <br />