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NOTE: PULL ALL,_�RMITS (Septic, Well, etc.) MAKE ..../PIES FOR FILE <br /> LAND USE REPORT RECORD IID: SU0004606 <br /> DATE RECEIVED by EHD: August 11,2004 APPL#: PA-04-450(PRE-AP Pre-Application <br /> Referral Agency STAFF CONTACT: GILLIAN HAYES PE : 2622 <br /> SUBDIVISON-MINOR(MS) <br /> COMPLETE&SUBMIT BY: Wed, September 1, 2004 <br /> Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: 9501 E JAHANT RD,ACAMPO APN : 00731011 <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: 1 Public Sewer: <br /> Name of Purveyor Name of System <br /> SUMMARY OR COMMENTS: <br /> /x•'03 <br /> i <br /> �. oa <br /> I rec mmend: Approva Denial Continuance Inspec r: <br /> -D/ i Signature <br /> Supervisor/Lead Senior COM ENTS: <br /> C. a;)- :O�k- Pum( /I w <br /> �. IS:Os- <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> OA 11 Check OH List: Proofread Report? .. Correct LAND USE#?' <br /> Correct CONDITION(S)? .:: Logged•in LAND USE:.Book? - - <br /> EH 06 06 Report#7201 Page 5 August 13,2004 <br />