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NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE CdPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0004653 <br /> DATE RECEIVED by EHD: October 04,2004 APPL#: PA-03-48(TE) <br /> Referral Agency STAFF CONTACT: JOHN FUNDERBURG PE : 2690 <br /> LOT LINE ADJUSTMENT(LA) <br /> COMPLETE& SUBMIT BY: <br /> Assigned to : EE0000149 BORGES <br /> SITE ADDRESS: 25992 N ELLIOT RD, GALT APN : 00722011 <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 /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> OA 11 Check Off List.., : _.Proofread Report? -- Correct LAND USE#?" <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> EH 06 06 Report 47201 Page I October 08,2004 <br />