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NOTE: PULL ALL FERMITS (Septic, Well, etc.) MAK OPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0004965 <br /> DATE RECEIVED by EHD: March 29,2005 APPL#: PA-04-566 <br /> Referral Agency STAFF CONTACT: CHANDLER MARTIN PE : 2611 <br /> SUBDIVISION-MAJOR(SU) <br /> COMPLETE& SUBMIT BY: Tue, April 19, 2005 <br /> Assigned to • EE0000811 HUGGINS <br /> SITE ADDRESS: NEIGHBORHOOD H ,MOUNTAIN HOUSE APN: <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 camplete 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 /> D/I�/; <br /> I recommend: Approval ❑ Denial F-1 Continuance F-1 Inspector: <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <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 Page 8 March 30,2005 <br />