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•* r <br /> NOTE: PULL ALL ERMITS (Septic, Well, etc.) MAK OPIES FOR FILE <br /> LAND USE REPORT RECORD ID• 00-5-0611 <br /> DATE RECEIVED by EHD: May 24,2005 AP f.lz; I <br /> Referral Agency STAFF CONTACT: KATHY ALLEN PE : 2656- d <br /> NS TO ACTIONS (Ra) <br /> COMPLETE & SUBMIT BY: Tue, June 7, 2005 <br /> Assigned to : EE0000811 HUGGINS <br /> SITE ADDRESS: 11651 E PALM AVE, RIPON APiN : 22809005 <br /> [n completing the Land Use investigation, draw all Public Health factors on the exhibit(i.e., sewvaae 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 S\stem <br /> SUMMARY OR COMMENTS: <br /> �. -2 6 ,o� <br /> oa ,v/ <br /> Ox • � <br /> I recommend: Approval 1-1 Denial ❑ Continuance F-1 Inspector: <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> SUPERVISOR/ LEAD SENIOR Approval: Date: <br /> OA it Check Off List: Proofread Report? Correct LAND USE#? <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> l:11 00 06 Report 47201 play 26,200-1 <br />