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NOTE: PULL ALLL.RMITS (Septic, Well, etc.) MAKE LJPIES FOR FILE' <br /> LAND USE REPORT RECORD ID: SU0004703 <br /> DATE RECEIVED by EHD: November 15,2004 APPL#: PA-04-664 <br /> Referral Agency STAFF CONTACT: RAY HOO PE : 2631 <br /> SITE APPROVAL-MINOR(SA) <br /> COMPLETE& SUBMIT BY: Tue, December 7, 2004 <br /> Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: 17801 E ST RT SS HWY,LOCKEFORD APN : 01922021 <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 /> Name of Purveyor Name of System <br /> SUMMARY OR COMMENTS: <br /> �y <br /> a7 0 <br /> I recommend: Approval Denial Continuance <br /> ignature <br /> Supervisor/Lead Senior COMMENTS: <br /> R <br /> or IV <br /> M <br /> SUPERVISOR/LEAD SENIOR Approval: Date: f �i <br /> �A 11 <br /> . Check t "Prpofead Report?. <br /> oSE# <br /> cC CGNDITIO�(5) ? Logged Bb�k7Corre <br /> f <br /> a <br /> EH 06 06 Report#7201 Page 5 November 17,2004 <br />