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NOTE: PULL AL iERMITS (Septic, Well, etc.) MAKE.,-OPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0008842 <br /> DATE RECEIVED by EHD: August O1,2011+ APPL#: PA-1100126 <br /> Referral Agency STAFF CONTACT: JOHN L FUNDERBURG PE , 2690 <br /> ---------------- <br /> LOT LINE ADJUSTMENT.(LA) <br /> COMPLETE & SUBMIT BY: f .. <br /> Assigned to : EV0005944 ESCOTTO <br /> SITE ADDRESS: 11861 E HWY 12 ,LOCKEFORD APN : 05118038 39 <br /> In completing the Land Use investigation, draw all Public Health factors-o -10e c hi9111t .e se age Edi pawl, water <br /> supplies, etc...). Where necessary, on an attached piece of plain pa erkdra com ete mea ' . <br /> p p, p of areaslsovvng 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 /> 1 recommend: Approval © Denial Ll Continuance Inspector: <br /> Supervisor/Lead Senior COMMENTS: <br /> Signature <br /> f ` <br /> i. <br /> LAI.. = r3 <br /> S <br /> ie <br /> SUPERVISOR I LEAD SENIOR Approval Date. Q <br /> ..s'. ..'6 € rr `T - <br /> 0.4 1!Check Dff�rsf � { �r1�ad,I�epart `r,' <br /> p ND, <br /> � .tea' d%. ..�y, ��.� <br /> 8 d .:& .� <br /> r'" p1 G6zreCt CC7NDITiIO p L� <br /> "�Z?xx. €itiJ 1' in`It` D '1a ;` <br /> EH 06 06 Report 47201 <br /> August 01,2011 <br />