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NOTE: PULL AIWPERMITS (Septic, Well, etc.) MAKVftOP1ES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0004757 <br /> DATE RECEIVED by EHD: December 21,2004 APPL#: PA-04-770 <br /> Referral Agency STAFF CONTACT: JIM VAN BUREN PE : 2632 <br /> SITE APPROVAL-GENERAL(SA) <br /> COMPLETE&SUBMIT BY: ft I <br /> V —4�— Assigned to : EE0009374 GODINHO <br /> SITE ADDRESS: 11651 E PALM AVE, 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 /> it <br /> I recommend: Approval Dwfial,47 Continuance Inspector: <br /> Signature <br /> Sunervisor/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 Page 6 December 27,2004 <br />