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DOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0010209 <br /> DATE RECEIVED by EHD: August 18,2014 APPL##: PA-1400134 <br /> Referral Agency STAFF CONTACT: JOHN FUNDERBURG PE : 2656 <br /> REVISIONS TO ACTIONS (RA) <br /> COMPLETE&SUBMIT BY: Mon, September 8, 2014 <br /> Assigned to : EE0004045 TASIOPOULOS <br /> SITE ADDRESS: 768 N MONTEBELLO ST, 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 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 COM ENTS: <br /> I recommend: Approval ® Denial El Continuance El Inspector• <br /> ignature <br /> Sunervisor/Lead Senior COMMENTS: <br /> SUPERVISOR/LEAD SENIOR Approval: Date: Z <br /> OA 11 Check OK List: proofread Report? Correct LAND USE#? <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> EH 06 06 Report 07201 August 29,2014 <br />