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k <br /> ,NOTE: PULL ALL-.,ERMITS (Septic, Well, etc.) MAKi—VGPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0004793 <br /> DA'T'E RECEIVED by EHD: January 20,2005 APPL#: PA-05-13 <br /> Referral Agency STAFF CONTACT: RAYMOND HOO PE ; 2625 <br /> USE PERMIT-MINOR(UP) <br /> COMPLETE&SUBMIT BY: Wed, January 28, 2005 <br /> Assigned to EE0005366 MEDINA <br /> SIVE ADDRESS: 17801 E ST RT 88 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 /> (2 - <br /> zz <br /> D.� <br /> C <br /> I recommend: Approval` Denial Continuance F-1 Inspector: <br /> � � � ��� nature <br /> Su erysor/Lead Senior COMMENTS: - =�— <br /> f <br /> SUPERVISOR/LEAD SENIOR Approval: Date: ut �- Lj <br /> OA it Check Off List Proofread Report? Correct LAND USE#? <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> EH 06 06 Report 97201 Page 2 January 21,2005 <br />