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f <br /> NOTE: PULL AL:. 'ERMITS (Septic, Well, etc.) MAK._)OPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0005250 <br /> DATE RECEIVED by EfID: July 25,2005 APPL#: PA-0500462 <br /> Referral Agency STAFF CONTACT: RICK GRIFFIN PE : 2631 <br /> SITE APPROVAL-MINOR(SA) <br /> COMPLETE & SUBMIT BY: Wed, August 10, 2005 <br /> Assigned to : EF-0003973 MCCLELLON <br /> SITE ADDRESS: 17950 W VIA NICOLO RD, TRACY APN : 20911031&32 <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 Denial Continuance ❑ Inspector: <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> x <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> e R. W�' ai <br /> _ofre'0°; ,f Correct C:;ONDITIdN(Sd in LA3�O 175E 13o <br /> EH 06 06 Report#7201 July 26,2005 <br />