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NOTE: PULL ALL ,_RMITS (Septic, Well, etc.) MAKE"':+PIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0004611 <br /> DATE RECEIVED by EHD: August 18,2004 APPL#: PA-04-467 <br /> Referral Agency STAFF CONTACT: JIM VAN BUREN JR PE : 2690 <br /> p IAT LINE ADJUSTMENT(LA) <br /> COMPLETE&SUBMIT BY:A 17-0/,) a( <br /> Assigned to : EE0000149 BORGES <br /> SITE ADDRESS: 1836 N SUTRO AVE, STOCKTON APN : 14314010 <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 /> Supervisor/Lead Senior COMMENTS: <br /> (J <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> A I/Cheek Off Lis—t• :: 'roofread Report?': Co <br /> CorrectCQN6 0N(S)7 �:< c Aged in LANA VSE-Bcagk7 <br /> EH 06 06 Report#7201 Page 3 August 20,2004 <br />