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r7" <br /> N <br /> NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0004781 <br /> DATE RECEIVED by EHD: January 18,2005 APPL#: PA-05-02 <br /> Referral Agency STAFF CONTACT: KEVIN SWANSON PE : 2690 <br /> COMPLETE& SUBMIT BY: 1/1),1/0LOT LINE ADJUSTMENT(LA) <br /> "— Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: 11914 E BRANDT RD,LO RD APN: 05118020& <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: n-� Public Sewer: <br /> Name of Purveyor Name of System <br /> SUMMARY OR COMMENTS: <br /> n� <br /> I recommend: Approval Denial Continuance Insp ctor: ,-' <br />- Si ature <br /> Suoervisor/Lead Senior COMMENTS: <br /> ti <br /> Gang-��v - rr( �•( �.r v <br /> r <br /> SUPERVISOR/LEAD SENIOR Approval: Date: J <br /> OA 11 Check Off List: Proofread Report? Correct LAND USE#? <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> EH 06 06 Report 47201 Page I January 20,2005 <br /> J <br /> t <br />