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NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0011922 <br /> DATE RECEIVED by EHD: September 05,2018 APPL#: PA-1800204 Pre-Application <br /> Referral Agency STAFF CONTACT: CHRISTINE LUCKASEN PE : 2631 <br /> SITE APPROVAL-MINOR(SA) A1,, t <br /> COMPLETE & SUBMIT BY: Wed, September 12, 2018 �M Z-0 9 — 3 _2 ?- — Z 3 4f{- N�r6T} <br /> ssigned to : EE0009488 WONG cti <br /> SITE ADDRESS: 12505 E BRANDT RD, LOCKEFORD , Zi/9 &uf <br /> APN : 05132010 <br /> In completing the Land Use investigation, draw all Public HealJ4 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 jirection, etc.... <br /> Public Water: Public Sewer: <br /> Name of Purveyorz6�i8 Name of System <br /> SUMMARY OR COMMENTS: U✓G �p y p frM is � I� 1 <br /> — tytl vj D 2; S 2 oo ' o rwr-� , ( I-r <br /> Yn l Z L 4` <br /> 8 C N arczc Vol I z zAV <br /> S Y-541LS to Wj LOZ00 0 1 Vj k Uses <br /> ! f a Vlh �v cwt al u YS r o <br /> 0 .q I <br /> f371� 60 ah s '� r U Cax <2000 / y <br /> I r commend: Approval benialEl Continuance Inspector: <br /> Signa re <br /> Supervisor/Lead Senior COMMENTS: <br /> PC- (��Il t, ., : 216Ct,/.J'C� T rX� UG SSS/.fiir c C�bt2c s�1 <br /> s <br /> F/1!/T /aN .o06kzc 6�b A/u n rsf ' Ib d7 lil.YCiJ� .Afit l Ire <br /> 124 <br /> u <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> if h k L• Proofread Report? Correct LAND USE#? <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> EH 06 06 Report#7201 September 06,2018 <br />