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NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0010231 <br /> DATE RECEIVED by EHD: September 18,2014 APPL#: PA-0900184 TE <br /> Referral Agency STAFF CONTACT: STEPHANIE STOWERS PE : 2627 <br /> USE PERMIT-MAJOR(UP) <br /> COMPLETE&SUBMIT BY: Tue, October 7, 2014 <br /> Assigned to : EE0004045 TASIOPOULOS <br /> SITE ADDRESS: 1000 E ROTH RD, FRENCH CAMP APN : 19803020 23 27 28 29 31 <br /> i9fteeof 05 f6 <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 Inspects — <br /> ./ ignature <br /> Supervisor/Lead Senior COMMENTS: <br /> AA%X-"t— CIO S <br /> SUPERVISOR/LEAD SENIOR Approval Date: lol <br /> / k Off List Proofread Report? Correct LAND USE#? <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> EH 06 06 Report#7201 September 19,2014 <br />