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4 <br /> NOTE: PULL ALL-,,.iRINITS (Septic, Well, etc.) MAKE-..jm-&S FOR (FILE <br /> LAND USE REPORT RECORD ID: SU0004910 <br /> DATE RECEIVED by EHD: March 15,2005 APPL#: PA-05-129 <br /> Referral Agency STAFF CONTACT: GILLIAN HAYES PE : 2622 <br /> SUBDIvisON-MINOR(MS) <br /> COMPLETE&SUBMIT BY: Tue, April 5, 2005 <br /> Assigned to • EE0005944 ESCOTTO <br /> SITE ADDRESS: 400 N DIETRICH RD, LINDEN APN : 10522002 <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 lien al F-1ontinuance Inspector: <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> oll <br /> C . <br /> VV <br /> 1 <br /> o <br /> Z2 / <br /> SUPERVISOR 1 LEAD SENIOR Approval: Date: <br /> OA I!Check Off List: Proofread Report? Correct LAND USE#? € <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> EH 06 06 Report#7201 Page 3 March 16,2005 <br />