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.. <br /> z NOTE: PULL ALL""RMITS (Septic, Well, etc.) MAKE._.iPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0004485 <br /> DATE RECEIVED by EHD: May 20,2004 APPL#: PA-04-256 <br /> Referral Agency STAFF CONTACT: RICK GRIFFIN PE : 2690 <br /> LOT LINE ADJUSTMENT(LA) <br /> COMPLETE& SUBMIT BY: IS (PV"'r-%Ck -,4 Assigned to : EE0000149 BORGES <br /> SITE ADDRESS: 11301 E WEST RIPON RD, RIPON APN : 22813023 &24 <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 /> !RE I <br /> I <br /> f <br /> SUPERVISOR/LEAD SENIOR Approval: Af Date: t"" <br /> Proofread.Re ort '`._ <br /> r:DA I!Check OfiLlsf: P - Correct`�,AND USE <br /> Correct CONDITIONS)? L�d in LAND USE�Book? <br /> EH 06 06 Report 47201 Page 9 May 24,2004 <br />