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NOTE: PULL ALL .. MITS (Septic, Well, etc.) MAKE`PIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0004556 <br /> DATE RECEIVED by EHD: July 13,2004 APPL#: PA-02-508 crin-fy CA. <br /> Referral Agency STAFF CONTACT: LEANNE MUELLER PE : 2632 <br /> SITE APPROVAL-GENERAL(SA) <br /> COMPLETE& SUBMIT BY: Tue, August 3, 2004 <br /> Assigned to : EE0000149 BORGES <br /> SITE ADDRESS: 11156 S MCKINLEY AVE, FRENCH CAMP APN : 19332020 <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 ❑ Continuance ❑ Inspector: <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> ZA-'f /-O• — /0-3m GLL� <br /> VV P:uGIG� <br /> r <br /> 'ATERVISOR/ LEAD SENIOR Approval: ! Date: <br /> Proofread Report? Correct LAND USE#? i <br /> I OA 11 Check Off List: ;- <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> EH 06 06 Report#7201 Pagc 3 I my 16,2004 <br />