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NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0003412 <br /> DATE RECEIVED by EHD: April 06,2004 ADPL M. PA-03-153 <br /> Referral Agency STAFF CONTACT: JENNIFER JOLLEY PE : 2632 <br /> SITE APPROVAL-GENERAL(SA) <br /> COMPLETE&SUBMIT BY: Tue, April 20, 2004 Assigned to : EE0000149 BORGES <br /> SITE ADDRESS: 10830 S HARLAN RD, FRENCH CAMP APN : 19333028 <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 /> apt e�elll ea ` . �,� <br /> I re ommend: Approval ❑ Denial 0 Continuance El Inspector: <br /> Signature <br /> Sue visor/Lead``S,,ryryenior COMMENTS: <br /> 60 <br /> ). O3_ <br /> l'm 3 57i <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> OA 11 Check ON List Proofread Report? Correct LAND USE#? <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> EH 06 06 Report#7201 Page I April 12,2004 <br />