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NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0013225 <br /> DATE RECEIVED by EHD: May 01,2020 APPL#: PA-2000016 <br /> Referral Agency STAFF CONTACP. ALISA GOULART PE : 2632 <br /> SITE APPROVAL-GENERAL(SA) <br /> COMPLETE&SUBMIT BY: Thu, May 28, 2020 <br /> Assigned to: EE0000418 KITH <br /> SITE ADDRESS: 865 E ROTH RD, FRENCH CAMP APN : 19332026 <br /> In completing the Land Use investigation, draw all Public Health factors on the exhibit(i.e., sewage disposal, water sup] <br /> etc...). Where necessary, on an attached piece of plain paper, draw complete map of area showing population density, loc <br /> of house, wind direction, etc.... <br /> Public Water: 4k,,,4 Public Sewer: <br /> Name of Purveyor Name of System <br /> SUMMARY OR COMMENTS: <br /> L-k w,kj-- -ro c,v. c S�— 0 0 —7 I 1p F n Q S¢_,?T i m 1'--)t•S i k_.0 c "t T"o t-J <br /> ht%*4 gglw� <br /> I recommend: Approval ❑ Denial ❑ Continuance F-1 Inspector: <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> SUPERVISOR/LEAD SENIOR Approval: Date: ze L2 <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 May 05,2020 <br />