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NOTE: PULL ALL , MITS (Septic, Well, etc.) MAKE `IES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0004679 <br /> DATE RECEIVED by EHD: October 21,2004 APPL#: PA-04-584 <br /> Referral Agency STAFF CONTACT: KEVIN SWANSON PE : 2631 <br /> SITE APPROVAL-MINOR(SA) <br /> COMPLETE& SUBMIT BY: Tue, November 2, 2004 <br /> Assigned to : EE0005944 ESCOTTO <br /> SITE ADDRESS: 19040 E ST RT 26 HWY, LINDEN APN : 10517044 <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 /> ' 1�,���L,l�c/�iib�7��� C%tzZ�l�L�.9�d42�S' /�/L� 6f1�/T�� 15�►✓�/� Z 59�=<,✓ <br /> /�f3Glu-Q�.i/C-� ��,c C�.c�"ci9�•.//-� G��r3GCS�-�S€�S <br /> 5 .4i1�`,4, i-4 <br /> �) p•'�� 8� Z�;cam. �) �S�•�/ <br /> I recommend: Approval Denial Continuance � Inspector: <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> d <br /> D : 0 <br /> 8 . ao ; or <br /> SUPERVISOR/LEAD SENIOR Approval: _ Date: d ?j 'L-'y <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#7201 Page 19 October 22,2004 <br />