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NOTE: PULL AL4'14kMITS (Septic, Well, etc.) MAKk-,M-43 FOR FILE <br /> LAND 6SIE REPORT RECORD ID: SU0004861 <br /> DATE RECEIVED by EHD: March 01,2005 APPL#: MS-01-40(TE) <br /> Referral Agency STAFF CONTACT: KEVIN SWANSON PE : 2622 <br /> COMPLETE&SUBMIT BY: Tue, March 22, 2005 SUBDIVISON-MINOR(MS) <br /> Assigned to : EE0000149 BORGES <br /> SITE ADDRESS: 9122 E PELTIER RD,ACAMPO APN : 0171801 <br />' ixi cotnpieurig he 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 /> I recommend: Approval ❑ Denial ❑ Continuance ❑ Inspector: <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> OA li Check Off List: Proofread Report? Correct LAND USE#? <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> EH 06.06 Report#7201 Page 3 March 02,2005 <br />