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NOTE: PULL ALL`,. RMITS (Septic, Well, etc.) MAKE...t)P1ES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0004646 <br /> DATE RECEIVED by EHD: September 28,2004 APPL#: PA-02-632 (TE) <br /> Referral Agency STAFF CONTACT: KATHY ALLEN PE : 2627 <br /> USE PERMIT-MAJOR(UP) <br /> COMPLETE& SUBMIT BY: Tue, October 19, 2004 <br /> Assigned to : EE0000149 BORGES <br /> SITE ADDRESS: 18566 N ST RT 99 HWY, ACAMPO APN : 01709030 <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 /> I recommend: Approval ❑ Denial ❑ Continuance F-] Inspector: <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> OA 11 Check Off List: Proofread Report? ,' Correct LAND USE#? <br /> Correct CONDTi'ION(S)? Logged in LAND USE Book? <br /> EH 06 06 Report#7201 1'a_L'e, September 30,2004 <br />