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NOTE: PULL ALL PIERMITS (Septic, Well, etc.) MAKE�MP1ES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0005032 <br /> DATE RECEIVED by EHD: May 10,2005 APPL#: PM-820101 <br /> Referral Agency STAFF CONTACT: KARLA KHUL PE : 2656 <br /> REVISIONS TO ACTIONS (RA) <br /> COMPLETE &SUBMIT BY: Tue, June 7, 2005 <br /> Assigned to : EE0000149 BORGES <br /> SITE ADDRESS: 6262 E LIBERTY RD, GALT APN : 00524023 <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 /> ('6g..j CA c <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> OA 11 Check OH List: Proofread Report? Correct LAND USE#? <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> EH 06 06 Report#7201 May 13,2005 <br />