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NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> LAND USE REPORT RECORD ID: S00004968 <br /> DATE RECEIVED by EHD: April 05,2005 APPL#: PA-05-183 <br /> Referral Agency STAFF CONTACT: RICK GRIFFIN PE : 2690 <br /> LOT LINE ADJUSTMENT(LA) <br /> COMPLETE & SUBMIT BY: , 1. os <br /> Assigned to: EE0005366 MEDINA <br /> SITE ADDRESS: 6262 E LIBERTY RD, GALT a APN : 00524023 <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 /> ame of Purveyor Name of System <br /> SUMMARY OR COMMEN�. <br /> n <br /> 1��-tea <br /> I recommend: Approva Denial 0 Continuance Inspe <br /> Si nature <br /> Supervisor/Lead Senior COMMENTS: r <br /> F 1- _ l : 0!0 i�/t �c� rico c�62�/�- ✓u- �a cr t uu <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 47201 Pa_r 2 Apnl U?.100 <br />