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i NOTE: PULL ALL`PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0004784 <br /> DATE RECEIVED by EHD: January 18,2005 APPL#: PA-02-632 (TE2) <br /> Referral Agency STAFF CONTACT: KATHY ALLEN PE : 2656 <br /> /IJJ REVISIONS TO ACTIONS-STAFF <br /> COMPLETE&SUBMIT BY: Tue, February `I, 2005 REVIEW APPL(SR) <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 ❑ Inspector: <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> 11 , ✓y`-0 40 <br /> r <br /> L- <br /> Q <br /> Lotl <br /> - 9, <br /> 004 <br /> SUPERVISOR/ LEAD SENIOR Approval: Date: <br /> OA 11 Check Off List: Proofread Report? t;: Correct LAND USE#?— <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> EH 06 06 Report#7201 Page 3 January 21,2005 <br />