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NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0010470 <br /> DATE RECEIVED by EHD: April l4,2015 APPL#: PA-1500064 <br /> Referral Agency STAFF CONTACT: MO HATEF PE : 2620 <br /> DEVELOPMENT AGREEMENT(DA) <br /> COMPLETE& SUBMIT BY: Tue, May 5, 2015 <br /> Assigned to : EE0004045 TASIOPOULOS <br /> SITE ADDRESS: 1000 E ROTH RD, FRENCH CAMP APN : 19803020 23 27 28 29 31 <br /> 1198200011 05 16 <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 .El Denial ❑ Continuance ❑ Inspector: <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> A 11 Check Off List- Proofread Report? Correct LAND USE#? <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> EH 06 06 Report#7201 Anril 20.2015 <br />