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r " <br /> NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> LAND USE REPORT RECORD H): S00009789 <br /> DATE RECEIVED by EHD: October 04,2013 APPL#: PA-1300175 <br /> Referral Agency STAFF CONTACT: JOHN L FUNDERBURG PE : 2690 <br /> �S A ^ LOT LINE ADJUSTMENT(LA) <br /> COMPLETE & SUBMIT BY: T(J ti11o1i3 <br /> —}—T—� Assigned to: EE0005944 ESCOTTO <br /> SITE ADDRESS: 29020 N JACK TONE RD, GALT APN : 00719013& 15 <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: _ I <br /> �'�!� ll�✓� ' LClJI� // �- /ice R � l(Zt <br /> - �tls�z� z�J . l✓d��/��1 <br /> P,alejc7 70 Z /fi= ✓.��s / rf <br /> �.his 11�—�+.17� Ute' %!�E��lt/�Z/,�f�`*IIFi .cs — •�D�12[ 1< <br /> rr r�As7u✓tE`!�� <br /> — ����Vr19t{i�-FZto�ls <br /> I recommend: Approval Denial Continuance Inspector: <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> OL 7 IR —N kt --r t �e <br /> SUPERVISOR/LEAD SENIOR Approval: Date: floU <br /> ill! 511 <br /> EH 06 06 Report 47201 <br /> October 07,201' <br />