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{ �1 <br /> NOTE: PULL Al.b. ARMITS (Septic, Well, etc.) MAK PIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0005759 <br /> DATE RECEIVED by EHD: November 04,2005 APPL#: PA-0500671 <br /> Referral Agency STAFF CONTACT: KARLA KUHL PE: 2622 <br /> SUBDIVISON-MINOR(MS) <br /> COMPLETE&SUBMIT BY: Tue, December 6, 2005 <br /> Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: 26170 N JACK TONE RD, GALT APN: 02102002 <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 /> aa:oa <br /> spa:of <br /> I recommend: Approval Denial Continuance ❑ Insp ct <br /> 9jignature <br /> Supervisor/Lead Senior COMMENTS: <br /> SUPERVISOR/ LEAD SENIOR Appro�,sl: Date: <br /> OA 11 Check Off List: Proofread Rep);` Correct LAND US1, ? �i <br /> Correct CONDII IOtil ,i'' 1.o,2,cd in I-AND IISI:'.Book! <br /> EH 06 06 Report 07201 <br />