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NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0009106 <br /> DATE RECEIVED by EHD: March 16,2012 APPL#: PA-1200034 <br /> Referral Agency STAFF CONTACT: MO HATEF PE : 2625 <br /> USE PERMIT-MINOR(UP) <br /> COMPLETE&SUBMIT BY: Wed, March 28, 2012 <br /> Assigned to: EE0005944 ESCOTTO <br /> SITE ADDRESS: 19258 N JACK TONE RD,LOCKEFORD APN: 01906003 <br /> [n 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 L Name of System <br /> SUMMARY OR COMMENTS: 4 Lis» t� 1&�2/272" 75 _ <br /> GYLSlR=_F�S�EZ 'Z��i ): r'3/ZL//Z) <br /> EXC,c-9>TicZ—r L/�icsZ/i3G.-li," �c 5r1���✓ sI� u��r r u�/�,�v�,�� <br /> 6L-0 <br /> • /x/.�,.t� Lvf7eZ � '�- *-1�L /�f/7/'4faf}i�i� <br /> I recommend: Approval12 <br /> Dcnial Continuance Inspecto <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> d <br /> (� /0 . 04 <br /> (z� yo :0s <br /> SUPERVISOR/ LEAD SENIOR Approval: Date: �0 *• <br /> OA 11 Check Off List: Proofread Report? Correct L,1ND USC;it'? <br /> Correct CONDITION(S)? Logged in LAND USE Book'? <br /> IH❑r Vo Rcgar;�'7u- March 19,2012 <br />