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5 ' <br /> NOTE: PULL ALL 6. &MIT,B (Septic, Well, etc.) MAKE %moP1ES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0004515 <br /> DATE RECEIVED by EHD: June 15,200 APPL#: PA-04-170 Am <br /> r�7 <br /> Referral Agency STAFF CONTACT: RICK GRIFFIN PE : 2631 <br /> SITE APPROVAL-MINOR(SA) <br /> COMPLETE& SUBMIT BY: Tue, July 6, 2004 Assigned to : EE0000149 BORGES <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 ❑ Denial ❑ Continuance E Inspector: <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> SUPCRVISOR/ LEAD SENIOR Approval: Date: <br /> OA 11 Check OK List: Proofread Report? Correct LAND USE#? <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> EH 0606 Report#7201 Page <br />