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MOTE: PULL ALI: .=RMITS (Septic, Well, etc.) MAKE. 1 ;:,CIES FOR FILE <br /> LAND USE REPORT RECORD 1D: dp0g <br /> DATE'RECEIVED by EHD: _,___- APPL#t: PPS- 11060 2A <br /> Referral Agency STAFF CONTACT: PE RiLK � L �h_ ; 2(p3 2— <br /> COMPLETE &: SUBMIT BY: <br /> Assigned to <br /> SITE ADDRESS: 15405- S &)(b APN : V5240 2,+ <br /> In completing the Land Use investigation, draw all Public Health factors on the exhibit (i.e., sewage disposal, grater <br /> supplies, etc...). V,7here necessary, on an attached piece of plain paper, draw complete snap 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 /> Afl <br /> 4 _ <br /> E <br /> I recommend: Approval Denial � Continuance F] lRaw o <br /> 1 n—t.ure <br /> Supe visor/Lead Senior COMMENTS: <br /> ` d <br /> SUPERVISOR 1 LEAD SENIOR Approval: - -- Date: <br /> F 1 ' 'r I roo£reacl Reports s a s, CorreetTmtI�I7LSSE#�3 a ; :a <br /> (.�7EC{C7t)ff&M L �aeTe�^i3�, z 3,3a����.�.. � -s -,ih �.x k°g��i '�s�'r 3�:.', n� 5_'`,$ .v ✓� :'^rt"' ar.Ts �1 �; ',f5-: sh.`' �$:�..,its Z.y���r "�,�a��' i <br /> E14 06 06 Report 97201 October 17,2005 <br /> •i <br />