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NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> LAND USE REPORT RECORD ID: S4'000 9/.-2 ;?- (y 912 <br /> DATE RECEIVED by EHD: 5[3� 1, Z APPL#: fit-_9� _ q�� 7 j64- <br /> Referral Agency STAFF CONTACT: ��� Z-�,yj�r PE : 2-1,6-Z, <br /> COMPLETE&SUBMIT BY: LJ4- /3 'rer p f Z <br /> Assigned to: /1'7. L-SCai j la <br /> SITE ADDRESS: l�t�L(o� � C/ c� APN <br /> 17f.2CU 3.4_ <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 /> SUMMARY OR <br /> Name of Purveyor Name of System <br /> COMMENT4 <br /> iK S�S�� i ahrE'fG�'L7 <br /> 5 Jaz) <br /> 1 recommend: Approval ©' Denial _j Continuance � Inspecto . J <br /> Supervisor/Lead Senior COMMENTS, Signature <br /> SUPERVISOR/LEAD SENIOR Approval <br /> 7 Date / <br /> OA 11 Check OffGst Proofread Report Correct LANA USE# ? <br /> Correct CONDI7ION(S)? Logged in LAND USE Book? <br /> April 04,2012 <br />