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NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> LAND USE REPORT RECORD ID: S00009859 <br /> DATE RECEIVED by EHD: December 19,2013 APPL#: PA-1300007 <br /> Referral Agency STAFF CONTACT: CORINNE KING PE : 2631 <br /> SITE APPROVAL-MINOR(SA) <br /> COMPLETE&SUBMIT BY: Tue, January 7, 2014 <br /> Assigned to : EE0004045 TASIOPOULOS <br /> SITE ADDRESS: 865 E ROTH RD, FRENCH CAMP APN : 19332016 <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: /�Z �i'� Set Su dOfl 9s 3 5 /v, /1/ypfyy <br /> cL <br /> Z�- yy,, j ll 7 <br /> I recommend: Approval Denial E] Continuance Inspect - <br /> Supervisor/Lead Senior COMMENTS: <br /> U5' <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> DAN Chm*ON LJW > fi=d igrt? Combo LAND USE#? <br /> Correct CONDMON(S)? Logged in LAND USE Book? <br /> LH 06 06 Report#7201 December 20,2013 <br />