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r <br /> NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0004979 <br /> DATE RECEIVED by EHD: April 12,2005 ADPL#: PA-05-197 <br /> Referral Agency STAFF CONTACT: ANTONIO SALCEDO PE : 2690 <br /> LOT LINE ADJUSTMENT(LA) <br /> COMPLETE&SUBMIT BY:ASAR-Ul 4 <br /> Assigned to • EE0005944 ESCOTTO <br /> SITE ADDRESS: 25474 E HWY 4 , FARMINGTON APN : 18712022 <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 /> • ft P— Js'-f'r;-4 jo mag V%'C -U�r�c= <br /> 1 -7 <br /> af 43f 6d <br /> ""I recommend: Approval De ial Continuance ❑ Inspector• <br /> a:wF Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> [QA!1 Check Off List. Proofread Report? Correct LAND USE#? f <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> EH 06 06 Report 47201 Page 1 April 13,2005 <br />