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NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br />-AND USE REPORT RECORD 1D: S00009859 <br />DATE RECEIVED by EHD: December 19, 2013 APPL #: PA -1300007 <br />Referral Agency STAFF CONTACT: CORINNE KING PE : 2631 <br />SITE APPROVAL - MINOR (SA) <br />COMPLETE & SUBMIT BY: Tue, January 7, 2014 <br />Assigned to : F.;I:0004045 TASIOPOU LOS <br />SITE ADDRESS: 865 E ROTH RD, FRENCH CAMP APN : 19332016 <br />n completing the Land Use investigation, draw all Public Health factors on the exhibit (i.e., sewage disposal, water <br />;upplies, etc...). Where necessary, on an attached piece of plain paper, draw complete map of area showing population <br />lensity, location of house, wind direction, etc.... <br />Public Water: Public Sewer: <br />Name of Purveyor Name of System <br />recommend: Approval <br />supervisor/Lead Senior COMMENTS: <br />�5- <br />rcv,\ 7. Lv <br />Denial F1 Continuance <br />ol-PERVISOR 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 />N 06 06 Report #7201 <br />