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NOTE: PULL ALi.—ZRMITS (Septic, Well, etc.) MAKE.�PIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0005194 <br /> DATE RECEIVED by EHD: July 12,2005 APDL#: PA-0500324 <br /> Referral Agency STAFF CONTACT: KATHY ALLEN PE : 2690 <br /> LOT LINE ADJUSTMENT(LA) <br /> COMPLETE&SUBMIT BY: S <br /> N125. <br /> Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: 16880 E ST RT 88 , LOCKEFORD APN: <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: Hyl <br /> Name of Purveyor Name of System <br /> SUMMARY OR COMMENTSjS�GS � <br /> ate. oi, <br /> 1 recommend: Approval enial ❑ Continuance lnspe o �r <br /> Signature <br /> Suyervisor/Lead Senior COMMENTS: <br /> 60 <br /> f <br /> SUPERVISOR I LEAD SENIOR Approval: Date: <br /> a m.. .� <br /> %tee. <br /> EH 06 06 Report#7201 July 12,2005 <br />