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SU0011715
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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2600 - Land Use Program
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SU0011715
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Last modified
12/17/2019 10:31:36 AM
Creation date
10/4/2019 11:20:00 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
RECORD_ID
SU0011715
PE
2637
FACILITY_NAME
PA-1800030
STREET_NUMBER
21455
Direction
S
STREET_NAME
MOUNTAIN HOUSE
STREET_TYPE
PKWY
City
MOUNTAIN HOUSE
Zip
95391-
APN
20945036
ENTERED_DATE
3/21/2018 12:00:00 AM
SITE_LOCATION
21455 S MOUNTAIN HOUSE PKWY
RECEIVED_DATE
3/20/2018 12:00:00 AM
P_LOCATION
99
P_DISTRICT
005
QC Status
Approved
Scanner
SJGOV\sballwahn
Supplemental fields
FilePath
\MIGRATIONS\M\MOUNTAIN HOUSE PKWY\21455\PA-1800030\SU0011715\BOS OK.PDF
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EHD - Public
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NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0011715 <br /> DATE RECEIVED by EHD: March 20,2018 APPL#: PA-1800030 <br /> Referral Agency STAFF CONTACT JOHN FUNDERBURG PE : 2637 <br /> SPECIAL PURPOSE PLAN(PP) <br /> COMPLETE& SUBMIT BY: Mon, April 9, 2018 <br /> Assigned to : EE0000034 AHMED <br /> SITE ADDRESS: 21455 S MOUNTAIN HOUSE PKWY, MOUNTAIN APN : 20945036 <br /> HOUSE <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: A01G Public Sewer: Aft-� <br /> Name of Purveyor Name of System <br /> SUMMARY OR COMMENTS: <br /> — 4'A 0'r leVA'4j, o f r/K s; I e <br /> Leu+S�r e_�,y- y�ewy e•-- yta/ !�y/ �a ito ls <br /> Covin ew�s• <br /> �6 <br /> I recommend: ApprovalEF Denial ❑ Continuance ❑ Inspector: <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> a47 4- a <br /> O <br /> SUPERVISOR/LEAD SENIOR Approval: Date: Zz T-1 y <br /> OA 11 Check Off List: Proofread Report? Correct LAND USE#? <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> EH 06 06 Report#7201 March 21,2018 <br />
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