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NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> LAND USE RF-PORT RECORD ID: SU0010207 <br /> DATE RECEIVED by EHD: August 18,2014 APPL#: PA-1400132 <br /> Referral Agency STAFF CONTACT: JOHN FUNDERBURG PE : 2656 <br /> REVISIONS TO ACTIONS (RA) <br /> COMPLETE& SUBMIT BY: Mon, September 8, 2014 <br /> Assigned to : EE0004045 TASIOPOULOS <br /> SITE ADDRESS: 255 W LEGACY DR, MOUNTAIN HOUSE APN : 25423003 <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 /> e of Purveyor Name of System <br /> SUMMARY OR COMMENTS: <br /> I recommend: Approval 0 Denial F] Continuance Inspector: <br /> .y Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> d� <br /> C--L IA V"4 L; t- <br /> SUPERVISOR/LEAD SENIOR Approval: Date: Z <br /> OA II Check OK Li Proofread Report? Correct LAND USE#? <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> EH 06 06 Report#7201 August 29,2014 <br />