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NOTE: PULL ALL ERMITS (Septic, Well, etc.) MAKE PIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0004744 <br /> DATE RECEIVED by EHD: December 07,2004 APPL#: PA-04-730 <br /> Referral Agency STAFF CONTACT: JOHN FUNDERBURG PE : 2622 <br /> SUBDNISON-MINOR(MS) <br /> COMPLETE At SUBMIT BY: Tue, December 21, 2004 <br /> Assigned to : EE0005944 ESCOTTO <br /> SITE ADDRESS: 16113 S VICTORY RD, OAKDALE APN : 22922024 <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 /> Name of Purveyor Name of System <br /> SUMMARY OR COMMENTS: <br /> I recommend: Approval ❑ Denial F] Continuance F1 Inspector: <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> r Q � <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> OA 11 Check Off List: Proofread Report? Correct LAND USE#? <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> EH 06 06 Report 47201 Pag 10 December 13,2004 <br />