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NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0009454 <br /> DATE RECEIVED by EHD: December 21,2012 APPL#: PA-1200243 <br /> Referral Agency STAFF CONTACT: RI I r I PE : 2690 <br /> LOT LINE ADJUSTMENT(LA) <br /> COMPLETE& SUBMIT BY: <br /> Assigned to : EE0004045 TASIOPOULOS <br /> SITE ADDRESS: 18516 E HWY 120 , RIPON APN : 24507002 27 70 71 <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 eyor 1 Name of System <br /> SUMMARY OR COMMENTS: / 7 �7 _ C _ <br /> r. <br /> 1 recommend: Approvaln Denial Continuance Inspecto <br /> ignature <br /> Sunervisor/Lead Senior COMMENTS: <br /> (' <br /> SUPERVISOR/ LEAD SENIOR Approval: Date:. - <br /> OA Il Check Off List: Proofread Report'? _ Correct LAND.USE 4 ? <br /> Cca reet CONDI)10N(S)? Logged in LAND USE Book? <br /> December 21,2012 <br />