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Y <br /> 4 <br /> -'J NOTE: PULL•ALL4-_.RMITS (Septic, Well, etc.) MAKE }PIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0005292 <br /> DATE RECEIVED by EHD: August 09,2005 APPL#: PA-0500509 <br /> Referral Agency STAFF CONTACT: GILLIAN HAYES PE : 2611 <br /> SUBDIVISION-MAJOR(SU) <br /> COMPLETE& SUBMIT BY: Wed, August 31, 2005 <br /> Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: 14400 E ST RT 88 HWY, LOCKEFORD APN : 01911026,20,& <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 /> N f 1) e q—� Name of System i <br /> SUMMARY OR COMMENTSy <br /> ok <br /> ra• 05 <br /> ao. <br /> 1 <br /> I recommend: ApprovalEr Denial Continuance Inspe a <br /> ignature <br /> Supervisor/Lead Senior COMMENTS: <br /> � J <br /> Ant <br /> VV <br /> .- � . <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> _ - <br /> OA!l Check Off List - Proofread Repo( ) orrect LAS USE <br /> Correct CONDITIONS Lo ed in LAND-USE Book? <br /> EH 06 06 Report#7201 August 11,2005 <br />