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NOTE: PULL AL�__ZRMITS (Septic, Well, etc.) MAKE,-.JPIES FOR FILE <br /> LANEPORT RECORD ID: SU0008356 <br /> DATE RECEIVED by EHD: July 12,2010 APPL#: PA-0900192 <br /> Referral Agency STAFF CONTACT: MO HATEF PE : 2622 <br /> SUBDIVISON-MINOR(MS) <br /> COMPLETE&SUBMIT BY: Wed, July 21, 2070 <br /> Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: 751 E FOREST LAKE RD, ACAMPO APN : 00313001 <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: �f Public Sewer: <br /> Name of Purveyor Name of System <br /> SUMMARY OR COMMENTS: �� ��- - - - <br /> 1 recommend: Approval Denial Continuance Inspec <br /> S'gnature <br /> Supervisor/Lead Senior COMMENTS: <br /> e <br /> SUPERVISOR/LEAD SENIOR Approval <br /> - <br /> Date: <br /> r L <br /> Oi4 ff Gh'eckOff List r Ptoofrad`1tep4tt : s m 3 <br /> • � ,a 'irk77 <br /> ly¢rreGEONT3ITIQi S ND L7S <br /> EH 06 06 Report 47201 <br /> t ]uly 13,2010 <br />