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f MOTE: PULL AL: -RMITS (Septic, Well, etc.) MAKE`: -DPIES FOR FILE <br /> � zQ - <br /> LAND USE REPORT RECORD ID:6yop <br /> DATERECEIVEDby,EHD: � �� _ APPL#: PA�-ffW��j�' <br /> Referral Agency STAFF CONTACT: _ PE : gUgo '�-� 0 <br /> COMPLETE& SUBMIT BY: <br /> y I <br /> Assigned to �'l <br /> SITE ADDRESS: -r� hty M,IQ 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 '\Vater: Public Sewer: <br /> Name of Purveyor Name of System <br /> SUMMARY OR COMMENTS: l .� <br /> L <br /> f " <br /> Z recommend: Approval � Denial � Continuance � linspcet- <br /> �gnature/j <br /> Si_ 1pel_Jsor/Lead Senior COMMENTS: <br /> i <br /> r - <br /> E r � <br /> SUPERVISOR/LEAD SENIOR Approval; Date. <br /> I3 <br /> A�D I)S}~�. <br /> C3orrect� � r <br /> .�?. .. _���:�, r�. =,.F�.�:K% .,;>;ng d.��,N,M..:,..«s.. �,.;, »-r..-`.-to-,.. .::'.:..-�; .n-"''•_�S ,..��;r�'..X:ad 0�tii11; ���� �C19�Ci,::a_x#'.'z�.�'`��a�'. ". �.4�i�r�+ �� "u.i..3 C ;t. <br /> FH 06 06 Report 97201 October 17,2005 <br />