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NOTE: PULL ALL,f-,RMITS (Septic, Well, etc.) MAKE L.,PIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0005057 <br /> DATE RECEIVED by EHD: May 24,2005 APPL 4: PA-0500290 <br /> Referral Agency STAFF CONTACT: KATHY ALLEN PE : 2690 <br /> COMPLETE& SUBMIT BY: A <br /> LOT LINE ADJUSTMENT(LA) <br /> � <br /> $ <br /> Assigned to FE0004000 VAN DYNE <br /> �- <br /> SITE ADDRESS: 16417 S VICTORY RD, OAKDALE APN : 22922005,& 06 <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 /> J <br /> I recommend: Approval ❑ Denial Continuance Inspector: <br /> Su ervisor/Lead Senior COMMENTS: Signature <br /> vo <br /> A L Y <br /> w C ✓ <br /> S <br /> A <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> OA It Check Off List ` Probfrea'd Report?. US <br /> Correct LAND E 4 7 <br /> 'Correct CONDITION{3)? r <br /> T <br /> v+ A' `Logged in LAND USE Book.' t +. <br /> Eli 06 06 Report(#7201 May 25,2005 <br />