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NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0009043 <br /> DATE RECEIVED by EHD: January 27,2012 APPL#: PA-1200007 <br /> Referral Agency STAFF CONTACT: RIC G FFIN PE : 2690 <br /> COMPLETE &SUBMIT BY: LOT LINE ADJUSTMENT(LA) <br /> Assigned to : EE0004045 TASIOPOULOS <br /> SITE ADDRESS: 17001 S HASKELL LN, ESCALON APN : 22911014 <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 ofhouse, wi 'recYtitl, etc.... <br /> Public Water: Public Sewer:�— <br /> SUMMARY OR COMMENTS: <br /> Name of Purveyor Name of System <br /> I recommend: Approval Denial Continuance Inspector: <br /> Signature <br /> Supervisor/Lead Senior,GOMMENTS• <br /> v e <br /> SUPERVISOR/LEAD SENIOR Approval: Date: f Z' <br /> OA 11 Check Off List ProoGead Report? Correct LAND USE# ? <br /> Correct CONDITION(S)? bogged in LAND USE Book? <br /> GH 06 06 Report#7201 <br /> January 30,2012 <br />