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NOTE: PULL ALL'- RMITS (Septic, Well, etc.} MAKE PIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0007491 <br /> DATE RECEIVED by EHD: November 26,2008 APDL#: PA-0800353 <br /> Referral Agency STAFF CONTACT: EVA PAGE PE : 2690 <br /> LOT LINE ADJUSTMENT(LA) <br /> COMPLETE& SUBMIT BY: ASARBI�. <br /> Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: 17436 N HWY 88 , LOCKEFORD APN : 05125012 13 <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: fn2L?e ___ Public Sewer: <br /> Name of Purveyor Name of System <br /> SUMMARY OR COMMENTS: <br /> I recommend: Approval Denial Continuance Ins r: <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> i <br /> { <br /> I <br /> II <br /> i <br /> SUPERVISOR I LEAD SENIOR Approval: <br /> 0A4 Check Off L is# rapad Repot* <br /> tc. Iior(s) L ,- LAS WI <br /> EH 06 06 Report 47201 December 01,2008 <br />