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NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br />LAND USE REPORT RECORD ID: SU0009535 <br />DATE RECEIVED by EHD: February 20, 2013 <br />Referral Agency STAFF CONTACT: CORINNE KING <br />COMPLETE & SUBMIT BY: Wed, February 27, 2013 <br />APPL #: PA -1300007 <br />PE : 2631 <br />SITE APPROVAL - MINOR (SA) <br />Assigned to: EE0004045 TASIOPOULOS <br />SITE ADDRESS: 865 E ROTH RD, FRENCH CAMP APN : 19332016 <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 />3ensity, location of house, wind direction, etc.... <br />Public Water: j Public Sewer: <br />Name of Purveyor ^ Name of System <br />SUMMARY OR COMMENTS: <br />" <br />� <br />2, / - cG�� G 'f �� v 2-.?,-: v 3 — �:/.�1,�.//Y w� r,C I'll weho9 <br />[recommend: Approval- Denial Continuance Inspect <br />Signature <br />Supervisor/Lead Senior COMMENTS: <br />,Z1 -7 2 : oZ b <br />It•.�..1 � I � a:'� � � i St �..f�. J � t..r a �L � <br />i Biu <br />SUPERVISOR / LEAD SENIOR Approval: Date: <br />OA i! Check Off List: Proofread Report? Correct LAND USE # ? <br />Correct CONDITION(S) ? Logged in LAND USE Book? <br />EH 06 06 Report #7201 Fchruarn ,( 2'i] _ <br />