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NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0007455 <br /> DATE RECEIVED by EHD: October 31,2008 APPL#: PA-0800339 <br /> Referral Agency STAFF CONTACT: KEVIN SWANSON PE : 2631 <br /> SITE APPROVAL-MINOR(SA) _ <br /> COMPLETE &SUBMIT BY: Wed, November 12, 2008 <br /> Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: 25875 N FUFIRMAN 12D, ACAMPO APN : 02103058 <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 po <br /> density, location of house, wind direction, etc.... <br /> Public Water: j� Public Sewer: <br /> Name of Purveyor Name of System <br /> SUMMARY OR COMMENTS: <br /> oy <br /> aa. oa <br /> I recommend: Approval Denial Continuance Insp ct <br /> Sig afore <br /> Supervisor/Lead Senior COMMENTS: <br /> A� <br /> '2 '1 0 <br /> MFF- <br /> SUPERVISOR/ LEAD SENIOR approval: - " (- �- - � i Date: <br /> OA II Check Off List: Proofread Report? ConPcet LAND USE#?' <br /> Correct CONDITIQN(S)? _, Logged in:LAND USE;:Book?� . <br /> EH 06 06 Report#7201 November 05,2008 <br />