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NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0011360 <br /> DATE RECEIVED by EHD: May 19,2017 APPL#: PA-1200133 <br /> Referral Agency STAFF CONTACT ALISA GOULART PE : 2631 <br /> SITE APPROVAL-MINOR(SA) <br /> COMPLETE&SUBMIT BY: Tue, June 6, 2077 I ItPi �o(Tmsiun <br /> Assigned to : EE0004045 TASIOPOULOS <br /> SITE ADDRESS: 11075 W LARCH RD, TRACY APN : 21217002 <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 Purveyor Name of System <br /> SUMMARY OR COMMENTS: <br /> u t ZD/Z <br /> � zb <br /> I recommend: Approval Denial Continuance Inspector: <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> OA 11 Check Off List: Proofread Report? Correct LAND USE#? <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> EH 06 06 Report#7201 May 23,2017 <br />