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r--N • <br /> v NOTE: PULL ALt gJERMITS (Septic, Well, etc.) MAKS--JOP1ES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0005326 <br /> DATE RECEIVED by EHD: August 23,2005 APPL#: PA-0500510 <br /> Referral Agency STAFF CONTACT: CEALY LEIN PE : 2690 <br /> f '+� � LOT LINE ADJUSTMENT(LA) <br /> COMPLETE & SUBMIT BY:A�F-BY11 <br /> Assigned to : EE0004000 VAN DYNE <br /> SITE ADDRESS: 10650 E WEST RIPON RD, RIPON APN : 25724040,41,& <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: 1 <br /> I recommend: Approval Denial Continuance Inspector: <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> 3 <br /> SUPERVISOR/LEAD SENIOR Approval: <br /> Date <br /> :ate: <br /> 777. "r,;' r Pr00fFCad COITeCt I AtvTD USE# sP r¢i Kw r'4i iia F . <br /> OA r!check Of List:; M a , gam , t � > �a� <br /> 1 _¢ BOOk�t �"th.�,� :�1 e "` r -f if: " <br /> -x Correct CONDI I lO i(S)o e I ogged in L! hND USE � .,, WIN <br /> . <br /> GI 106 06 Report 47201 August 24,2005 <br />