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` li <br /> NOTE: PULL ALL PERMi'3'S (SEPTIC, WELL, ETC...) AKE COPIES FOR FILE <br /> LAND USE REPORT APP#: PA-04-28 (SA) <br /> EHD RECEIVED APP.REFERRAL: 2/10/04 COMPLETE & SUBMIT BY: 2-27-04 <br /> DATE DATE <br /> ATTN:_RICK GRIFFIN <br /> SITE ADDRESS: 26820 SOUTH HANSEN ROAD, TRACY <br /> In completing the Land Use investigation, draw all Public Health factors on the exhibit (i.e.: sewage disposal, <br /> water supplies, etc...). Where necessary, on an attached piece of plain paper, draw a completed map of area <br /> showing population density, location of house, wind direction, etc.... <br /> Public water: Public sewage: <br /> SUMMARY OR COMMENTS: <br /> I recommend: Approval L'Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> rP�-11 <br /> w <br /> 410±04 <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> EH 06 06 Rev 1/99 OA II CHECK OFF LIST.• Proofread report? Correct LAND USE#? <br /> Correct CONDITION(S)? Logged in ISI ND USE BOOK? <br />