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NOTE: PULL ALL*ERMITS (Septic, Well, etc.) MAKE "PIES FOR F � <br /> LAND USE REPORT RECORD ID: <br /> DATE RECEIVED by EHD: 7 -0-5 APPL#: Pa s <br /> Referral Agency STAFF CONTACT: 4isi 1 !/. PE : <br /> COMPLETE& SUBMIT BY: /� Y7_ 7�� <br /> Assigned to :� <br /> SITE ADDRESS: Q3 b /? s _/ . - r, C(:A APN <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 /> 15-&w &pvs, <br /> I recommend: Approval ❑ Denial F] Continuance Inspector: <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> SUPERVISOR/ LEAD SENIOR Approval: Date: <br /> OA 11 Check Off List: Proofread Report? Correct LAND USE#? <br /> Correct CONDITION(S)7 Logged in LAND USE Book? <br /> EH 06 06 Report P720 July 28,2005 <br />