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NOTE: PULL ALI RMITS (Septic, Well, etc.) MAKE PIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0004480 <br /> DATE RECEIVED by EHD: May 19,2004 APPL#: PA-04-249 <br /> Referral Agency STAFF CONTACT: RAYMOND HOO PE : 2631 <br /> SITE APPROVAL-MINOR(SA) <br /> COMPLETE& SUBMIT BY: Tue, June 1, 2004 Assigned to : EEOOOOI49 BORGES <br /> SITE ADDRESS: 21205 S WAGNER RD,RIPON APN : 24521001 <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 F-1Denial Continuance Inspector: <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> ,1 <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> OA I/Check Off List. Proofread Report`? f Correct LAND USE#? t I <br /> Correct CONDITION(S)? /F Logged in i AND USE Book? <br /> EH 06 06 Report#7201 �'+r Page 4 May 24,2004 <br />