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NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SupQpq/zp 6V <br /> DATE RECEIVED by EHD: 313o /I Z APPL#: 1'i4-07,903 72- <br /> Referral <br /> 2Referral Agency STAFF CONTACT: �J o c�DE�/�u2 G PE : &ZU <br /> COMPLETE&SUBMIT BY: f 3 , Zo z <br /> Assigned to : /Yl. CSco <br /> SITE ADDRESS: yo I U E /;,/N,7- i57-, 6 rwiLrD , APN:/43-336-.Zl <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 /> �)11l- /�L!�l'�at��s7��/z'� ��C1 i���n?�'-�� i 7!/�9s ���� / ✓Z /��Y�7 <br /> d�.k?) S��/9 7�TJ- L'�-/'��.'l'JP�n /ice. C?cdc r/y G� L/�•fZGf LucL.fG�J <br /> I recommend: Approval Denial Continuance Inspecto <br /> Supervisor/Lead Senior COMMENTS- Signature <br /> 1 <br /> l D l <br /> y l( <br /> IT 11 <br /> SUPERVISOR/LEAD SENIOR Approval: Date: ?J/ <br /> OA 11 Check Off List: Proofread Report? Correct LAND USE It <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> EH 06 06 Report#7201 <br /> April 04,2012 <br />