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NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> LAND USE REPORT RECORD ID: 500004999 <br /> DATE RECEIVED by EHD: May 03,2005 APPL 9: <br /> Referral Agency STAFF CONTACT: KATHY ALLEN PE : <br /> SITE APPROVAL-MINOR(SA) <br /> COMPLETE& SUBMIT BY: Tue, May 17, 2005 <br /> Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: 24400 N FUHRMAN RD, ACAMPO APN : 02104812 <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 /> I recommend: Approval LJDenial ❑ Continuance ❑ Inspec ori <br /> Si nature <br /> Supervisor/Lead Senior COMMENTS: <br /> 21 : 03 <br /> 0/ <br /> CS') : o1 <br /> F l � s : oy <br /> SUPERVISOR/ LEAD SENIOR Approval: Date: /'f <br /> OA 11 Check Off List Proofread Report? Correct LAND USE#? <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> EH 06 06 Report#7201 May 09,2005 <br />