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NOTE: PULL Al sev-sIRMITS (Septic, Well, etc.) MAKS.:JPIES FOR FILE <br /> AND USE REPORT RECORD ID: SU0005880 <br /> DATE RECEIVED by EHD: January 17,2006 APPL##: PA-0500537 <br /> Referral Agency STAFF CONTACT: CEALY LEIN PE : 2656 <br /> REVISIONS TO ACTIONS (RA) <br /> COMPLETE& SUBMIT BY: <br /> —- & Y-,,§— Assigned to : EE0004000 VAN DYNE <br /> SITE ADDRESS: 13343 S VAN ALLEN RD,ESCALON APN : 20513014 <br /> i completing the Land Use investigation, draw all Public Health factors on the exhibit (i.e., sewage disposal, water <br /> applies, etc...). Where necessary, on an attached piece of plain paper, draw complete map of area showing population <br /> ensity, location of house, wind direction, etc.... <br /> 'ublic Water: Public Sewer: <br /> Name of Purveyor Name of System <br /> UMMARY OR COMMENTS: <br /> 5 i/, s-g7 od 1-1194 _ <br /> recomm74 411,V" <br /> end: Approval Denial Continuance Inspector: <br /> Signature <br /> �u ervisor/Lead Senior COMMENTS: <br /> SUPERVISOR 1 LEAD SENIOR Approval: Dake <br /> P Co`rrecfl--AN1 C7SE <br /> OA!!Check Off List. _ roofread. ..Report, , i <br /> r F7fis. <br /> Correcf-aCONDIT!ON(S)T Q g8 <br /> EH 06 06 Report#7201 January 18,2006 <br /> 4 <br />