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NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br />LAND USE REPORT RECORD ID: SU0013225 <br />DATE RECEIVED by EHD: May 01, 2020 <br />Referral Agency STAFF CONTACT. ALISA GOULART <br />COMPLETE & SUBMIT BY: Thu, May 28, 2020 <br />APPL #: PA -2000016 <br />PE : 2632 <br />SITE APPROVAL- GENERAL (SA) <br />Assigned to: EE0000418 KITH <br />SITE ADDRESS: 865 E ROTH RD, FRENCH CAMP APN : 19332026 <br />In completing the Land Use investigation, draw all Public Health factors on the exhibit (i.e., sewage disposal, water supl <br />etc...). Where necessary, on an attached piece of plain paper, draw complete map of area showing population density, lo( <br />of house, wind direction, etc.... <br />Public Water: Ab" Public Sewer: ,4,,,e <br />Name of Purveyor Name of System <br />SUMMARY OR COMMENTS: , Q ��t S�o.�o �C-t d�j ynAW-3v\ <br />o <br />I s ( SU 16o t� <br />p C%*0' Rt) - NyS <br />I recommend: Approval ❑ <br />Supervisor/Lead Senior COMMENTS: <br />Denial ❑ Continuance ❑ Inspector: <br />SUPERVISOR / LEAD SENIOR Approval: <br />Date: <br />Signature <br />OA II Check Off List: Proofread Report? Correct LAND USE # ? I / I <br />Correct CONDITION(S) ? Logged in LAND USE Book? <br />EH 06 06 Report #7201 May 05, 2020 <br />