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F NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> LAND USE REPORT RECORD ID: L) p p 6p <br /> DATE RECEIVED byEHD: -us APPLft:�}-0L(QL7 q� , <br /> Referral Agency STAFF CONTACT: � yp�n ( wt }J PE : X2(031 <br /> S <br /> COMPLETE&SUBMIT BY: ��/ �G� <br /> Assigned to R, J <br /> SITE ADDRESS: 37 x 3 51 <br /> 54- <br /> 44-, <br /> • q 01 APN. N /So a;7 <br /> In completing the Land Use investigation, draw all Public Health factors on exhibit <br /> (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 F-1 Continuance ❑ Inspector: <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> OA It Check Off List Proofread Report? Correct LAND USE#? <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> EH 06 06 Report 47201 May 09,2005 <br />