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NOTE: PULL ALL PE.rMITS (Septic, Well, etc.) MAKE COBS FOR FILE <br /> LAND USE REPORT RECORD ID: 500004868 <br /> DATE RECEIVED by EHD: March 01,2005 APPL#: PA-05-92 <br /> Referral Agency STAFF CONTACT: KEVIN SWANSON PE : 2631 <br /> SITE APPROVAL-MINOR(SA) <br /> COMPLETE& SUBMIT BY: Tue, March 22, 2005 <br /> Assigned to : EE0005944 ESCOTTO <br /> SITE ADDRESS: c5l r� � APN : 19702005 <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 /> -AGGEr2t3J1�7 �GIJ� �ri Glls� �B�/«S �-Ty��Z) <br /> Get/Srl� ,ur1S°El Zc2�1 K 3/2aLe L5) <br /> iv T. .tom "sem-Z Zd1�5�� ' 4�L .�irA✓J�25 '�v�lL � f <br /> 11.E �Z''�---�ea'yJ .��7F,�t�✓i=��a�r�14,c.�= i�� w 6cm cc<.d�/�-cJ•i�!_�t3-.� <br /> ! -i�ZLI�G / GLDSC oa <br /> ' bu� ��i1fi�cT � �c��i-�Ic�JLf�1�4r��5 �.'c�5c>�t/[�J�f�l/12c�3tc�tf�•r��lam"���1�'c�� <br /> t 6- '4 :O <br /> I recommend: Approval 7 Denial F-1 Continuance ❑ Inspec _ <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> v <br /> IL2 <br /> - .., .� <br /> /fii F <br /> 3 - <br /> © s <br /> r / <br /> • <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#7201 Page 9 March 02,2005 <br />