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NOTE: PULL il.61e-gRMITS (Septic, Well, etc.) MAKE PIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0007283 <br /> DATE RECEIVED by EHD: July 14,2008 APPL 4: PA-0800205 <br /> Referral Agency STAFF CONTACT: PATRICK CROSBY PE ; 2631 <br /> SITE APPROVAL-MINOR(SA) <br /> COMPLETE & SUBMIT BY: Tue, August 5, 2008 <br /> Assigned to : HE0005366 MEDINA <br /> SITE ADDRESS: 14700 E SR 88 HWY, LOCKEFORD APN : 019-120-05 <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: lrv� Public Sewer: <br /> Name of Purveyor Name of System <br /> SUMMARY OR COMMENTS: <br /> I recommend: Approva Denial Continuance Ins ecto <br /> Sign ture <br /> Supervisor/Lead Senior COMMENTS: <br /> i <br /> f <br /> I <br /> i <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> `OA 11 Check Off L1sf <br /> aCorrect Cf]NDTTIQN s 7 = t' <br /> �x ( .�� «+ ` I,ogge �tn <br /> EH 06 06 Report 117201 <br /> July 14,2008 <br />