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NOTE: PULL ALL'6i,,.RMITS (Septic, Well, etc.) MAKE', ,_r-,.ES FOR FILE tI <br /> LAND USE REPORT RECORD ID: SU0005188 <br /> DATE RECEIVED by EHD: July 06,2005 APPL#: PA-0500407 <br /> Referral Agency STAFF CONTACT: RICK GRIFFIN PE : 2640 <br /> / �� LOT LI\E ADJUSTMENT(LA) <br /> COMPLETE& SUBMIT BY: �_ �..y „ '� — - <br /> Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: 23150 N JOHNSON RD, CLEMENTS APN : 02328001 & 04 <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 <br /> e of Purveyor '�70 e of System <br /> SUMMARY OR COMMENTS: <br /> c <br /> /i d <br /> f <br /> I recommend: Approval P:9�Denial Continuance Inspec <br /> gnatu re <br /> Supervisor/Lead Senior COMMENTS: <br /> • .e a <br /> Olt? P441 <br /> /j <br /> ... � .+1r+ Z <br /> ^ V ,. Q . / <br /> ai. <br /> f <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> OA 11 Check Off Lrst Proofread.Report? F Correct LAND USE ? ka <br /> Correct CONDITION(S)'.? �, ` � • <br /> �� .; Logged'li LAND USB Book? <br /> Ell 06 06 Repon 47201 July 06,2005 <br />