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Ak <br /> NOTE: PULL ALL RMITS (Septic, Well, etc.) MAK PIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0004124 <br /> DATE RECEIVED by EHD: May 12,2004 ADPL#: PA-04-234 <br /> Referral Agency STAFF CONTACT: JOHN FUNDERBURG PE : 2631 <br /> SITE APPROVAL-MINOR(SA) <br /> COMPLETE&SUBMIT BY: Tue, June 1, 2004 Assigned to : EE0000149 BORGES <br /> SITE ADDRESS: 17327 S VAN ALLEN RD, ESCALON APN : 20508025 <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 /> I recommend: Approval ❑ Denial ❑ Continuance ❑ Inspector: <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> a -d <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> P?A 11 Check Off List: Proofread Report? Correct LAND USE#? <br /> Correct CONDITION(S)? / Logged in LAND USE Book? <br /> EH 06 06 Report#7201 Page 15 May 12,2004 <br />