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NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> LAND USE REPORT RECORD ID: S00004973 <br /> DATE RECEIVED by EHD: April 05,2005 APPL#: PA-03-39 fZ <br /> Referral Agency STAFF CONTACT: KEVIN SWANSON PE : 2631 <br /> SITE APPRO AL--MINOR(SA) <br /> COMPLETE&SUBMIT BY: Tue, April 19, 2005 <br /> Assigned to : EE0000149 BORGES <br /> SITE ADDRESS: 15933 S MANTHEY RD, LATHROP APN : 19120010 <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 /> I recommend: Approval El Denial El Continuance El Inspector: <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> SUPERVISOR/ LEAD SENIOR Approval: Date. / <br /> OA lI Check Off List: Proofread Report? Correct LAND USE#? <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> EH 06 06 Repon 42111 \pnl 07. '_U4U <br />