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NOTE: PULL ALL w RMITS (Septic, Well, etc.) MAKE ` .PIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0004647 <br /> DATE RECEIVED by EHD: September 28,2004 APPL#: PA-03-259 <br /> Referral Agency STAFF CONTACT: BILL FACTOR PE : 2626 <br /> USE PERMIT-GENERAL(UP) <br /> COMPLETE&SUBMIT BY: Wed, October 6, 2004 <br /> Assigned to : EE0000149 BORCES <br /> SITE ADDRESS: MTN HOUSE , MOUNTAIN HOUSE APN : 20945011 <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 El Continuance El Inspector: <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> EH 06 06 Report 47201 Page 4 September 30,2004 <br />