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NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> LAND USE REPORT RECORD ID: S00009492 <br /> DATE RECEIVED by EHD: January 18,2013 APPL#: PA-0800061 Z <br /> Referral Agency STAFF CONTACT: MO HATEF PE : 2632 <br /> SITE APPROVAL-GENERAL(SA) <br /> COMPLETE& SUBMIT BY: Tue, February 5, 2013 <br /> Assigned to : EE0004045 TASIOPOULOS <br /> SITE ADDRESS: 11970 W LARCH RD, TRACY APN : 21219012 <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 /> [ recommend: Approval 10 Denial 1:1 Continuance El Inspect <br /> Ignature <br /> Supervisor/Lead Senior COMMENTS: <br /> dr <br /> SUPERVISOR/ LEAD SENIOR Approval: Date: <br /> OA it Cheek OH List: Proofread Report? CoiNct LAND USE 4? <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> Eli 06 06 Report 47201 January 22,201: <br />