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�t L <br /> i� NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE CidPIES FOR FILE <br /> RECORD ID: SU0003615 <br /> LAND USE REPORT <br /> j DATE RECEIVED by EHD: May 04,2004 <br /> ADPL#: PA-04-199 <br /> PE: 2690 <br /> Referral Agency STAFF CONTACT: RAYMOND HOO LOT LINE ADJUSTMENT(LA) <br /> II COMPLETE&SUBMIT BY: ` ,r„ Assigned to: EE0000149 BORGE5 <br /> APN : 00114002&03 <br /> SITE ADDRESS: 10101 W WALNUT GROVE RD, THORNTON <br /> In completing the Land Use investigation, draw all Public Health factors on the exhibit (i.e., sewage disposal,water <br /> S 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 <br /> Name of System <br /> SUMMARY OR COMMENTS: <br /> AAi! <br /> �N <br /> i� <br /> i� <br /> ii <br /> I! <br /> I! <br /> iIrecommend: Approval F� Denial Continuance El Inspector: <br /> ISignature <br /> II Su ervisorlLead Senior COMMENTS: <br /> P <br /> I� <br /> li <br /> i <br /> I <br /> I� <br /> SUPERVISOR I LEAD SENIOR Approval: Date: <br /> h Proofread Report? Correct LAND USE#? <br /> I= OA H Check Off List: <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> Ik <br /> May 10,2004 <br /> ES 06 Ofi Report#7201 Page 1 <br /> x ii <br />