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NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> LAND USE REPORT RECORD ID: Su 0 a0 g/z5 <br /> DATE RECEIVED by EHD: lav /I 2 APPL#: P-4 -100013Y TE <br /> Referral Agency STAFF CONTACT: .ere-le— PE : <br /> COMPLETE&SUBMIT BY: e— i3 r" 2 <br /> Assigned to: IY7. t✓5 eo u <br /> SITE ADDRESS: 7—?g 5 , /-/ 9Q� 5roeZn J APN: / 7% 172 36 <br /> In completing the Land Use investigation, draw all Public Health factors on the exhibit(i.e., sewage disposal, water `tib <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 /> `G"moi-7tt�7«✓s <br /> 41 &5- j; E sr r z <br /> iN7�i��'rrz�114�r� ��alc�i7 2�rrz� <br /> 1 recommend: Approval 12r Denial Continuance Inspecto . <br /> Supervisor/Lead Senior COMMENT ignature <br /> jc <br /> fZ 2v / U <br /> SUPERVISOR/LEAD SENIOR Approval: -!? Date: ' <br /> OA 11 Check ON List proofread Report? Correct LAND USE&# ? <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> ,H 06 06 Report#7201 <br /> April 04,2012 <br />