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-; 1 Pre <br /> NOTE: PULL ALC`rERMITS (Septic, Well, etc.) MAKEVbPIES FOR FILE <br /> LAND USE REPORT <br /> RECORD ID: SU0003417 <br /> DATE RECEIVED by ERD: April 09,2004 APPL#: PA-04-170 <br /> Referral Agency STAFF CONTACT: RICK GRIFFIN PE : 2632 <br /> SITE APPROVAL-GENERAL(SA) <br /> COMPLETE& SUBMIT BY: Y/ [/ Assigned to : EE0000018 TRINDADE <br /> SITE ADDRESS: 3721 S ST RT 99 W FRONTAGE RD, STOCKTON APN : 17915026 <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 F Denial ❑ Continuance El Inspector: <br /> Signature <br /> Supervisor/Lead Senior Comments: <br /> n 22 <br /> ' !? "J <br /> /O'a • US <br /> SUPERVISOR I 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 I April 09.2004 <br />