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1 <br /> NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPT S FOR FILE <br /> LAND USE REPORT RECORD ID: SU0004891 <br /> DATE RECEIVED by EHD: March 08,2005 APPL#: PA-05-80 <br /> Referral Agency STAFF CONTACT: RAYMOND HOO PE : 2622 <br /> SUBDIVISON-MINOR(MS) <br /> COMPLETE&SUBMIT BY: Tue, March 22, 2005 <br /> Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: 10122 N WEST LN, STOCKTON APN: 12002070 <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 /> ems! . <br /> Y <br /> I recomend. <br /> _pproval Denial Continuance Insp dor: ., <br /> ignature <br /> Supervisor/Lead Senior COMMENTS: <br /> IL <br /> _- aS <br /> za& Aucd 1/1.-9011oll� qg� eL <br /> IV V <br /> Q <br /> D,ww ✓ .v"'+� LI/1 fL...�JY'r'<<' K!X��'1�'k1 � � <br /> a ; c) 3 <br /> SUPERVISOR/LEAD SENIOR Approval: Date: Z <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 // 03 ca. Page 1 S. d / March 09,2005 <br /> i " <br />