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3 <br /> NOTE: PULL ALL',-4RMITS (Septic, Well, etc.) IMAAKE�4P ES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0007190 <br /> DATE RECEIVED by EHD: May 20,2008 APPL#: PA-0800165 <br /> Referral Agency STAFF CONTACT: JASON JONES PE : 2665 <br /> REZONING<5 acres(ZB) <br /> COMPLETE& SUBMIT BY: Wert, May 28, 2008 <br /> Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: 18303 N HWY 88 , LOCKEFORD APN : 05131029 <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 /> L:L"2 <br /> Name of Purveyor Name of System <br /> SUMMARY OR COMMENTS: � ��� <br /> I recommend: Approval Denial Continuance � Ins ctor: <br /> Sig ature <br /> Supervisor/Lead Senior COMMENTS: <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> '.0k[1111 Check Off List Proofread Repnrt Crreat I Sir 271, <br /> f <br /> t orrectQNt ITICIN(Sj?_ Lo ed in i r�0 USS BoJ�� e <br /> El 106 06 Report#7201 Play 21,2008 <br />