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I NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE C VIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0004764 <br /> DATE RECEIVED by EHD: December 21,2004 APPL#: PA-04-776(PA) <br /> Referral Agency STAFF CONTACT: JOHN FUNDERBURG PE : 2691 <br /> �q GEN PLAN AMENDMENT 10+acres(GP)r <br /> COMPLETE&SUBMIT BY: n1 s� �' <br /> . Assigned to : EE0000811 UGGINS <br /> II <br /> SITE ADDRESS: 6125 E QUASHNICK RD, STOCKTON APN : 08653002 <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 /> Suaervisor/Lead Senior COMMENTS: <br /> SUPERVISOR/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 �14j�Q � Page 2 December 31,2004 <br />