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5 <br /> NOTE: PULL ALL__,=RMITS (Septic, Well, etc.) MAKE,__rIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0005599 <br /> DATE RECEIVED by EHD: September 06,2005 APPL#: PA-0500542 <br /> Referral Agency STAFF CONTACT: JUN FUNDERBURG PE : 2690 <br /> LOT LINE ADJUSTMENT(LA) <br /> COMPLETE&SUBMIT BY:AM e 9 4 <br /> Assigned to : EE0004000 VAN DYNE <br /> SITE ADDRESS: 21205 S WAGNER RD, RIPON APN : 24521035 <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 <br /> F <br /> I <br /> I <br /> I recommend: Approval ® Denial Continuance Inspector• <br /> TignalTre <br /> Supervisor/Lead Senior COMMENTS: <br /> 'r <br /> i <br /> II <br /> I <br /> SUPERVISOR/LEAD SENIOR Approval: _ Date: Q�� <br /> '614 rth a b&Last, Prkofrd ep G ecC�A D C1 ' <br /> s Correct CO tT�Q ( ?�',. L"ogged itM USE BooksX6111 . <br /> �x, <br /> EH 06 06 Report#7201 September 08,'2005 <br />