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i <br /> NOTE: PULL ALLLERMITS (Septic, Well, etc.) MAKE' +OPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0004780 <br /> DATE RECEIVED by EHD: January 10,2005 APPL#: PA-04-799 <br /> Referral Agency STAFF CONTACT: GILLIAN HAYES PE : 2690 <br /> LOT LINE ADJUSTMENT(LA) <br /> COMPLETE&SUBMIT BY: <br /> Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: 34150 S GREENWOOD RD, TRACY APN : 22525007&09 <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 /> density, location of house, wind direction, etc.... <br /> Public Water: Public Sewer: <br /> Name of Purveyor Name of System <br /> SUMMARY OR COMMENTS: <br /> (r <br /> I recommend: Approval Denial Continuance Inspe <br /> Si nature <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)7 Logged in LAND USE Book? <br /> EH 06 06 Report#7201 Page 3 January 13,2005 <br />