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NOTE: PULL AL%.IERMITS (Septic, Well, etc.) MAKIMOPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0004652 <br /> DATE RECEIVED by EHD: September 28,2004 APPL#: PA-04-523 <br /> Referral Agency STAFF CONTACT: JIM VAN BUREN PE : 2633 <br /> SITE APPROVAL-MAJOR(SA) <br /> COMPLETE& SUBMIT BY: Tue, October 19, 2004 <br /> Assigned to : EE0009374 GODINHO <br /> SITE ADDRESS: 11651 E PALM LN, RIPON APN : 22809005 <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 /> S 37 3' <br /> I recommend: Approval © Denial ContinuanceEl <br /> Inspector: <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> o y. <br /> C k4 <br /> 2-0 <br /> - <br /> C'i-aC <br /> i <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> OA N Check Off List: Proofread Report? Correct LAND USE#? <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> EH 06 06 Report#7201 Page 9 September 30,2004 <br />