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NOTE: PULL ALL,.,2RMITS (Septic, Well, etc.) MAKL,_„)PIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0005802 <br /> DATE RECEIVED by EHD: December 06,2005 APPL#: PA-0500744 <br /> Referral Agency STAFF CONTACT: KEVIN SWANSON PE : 2632 <br /> SITE APPROVAL-GENERAL(SA) <br /> COMPLETE&SUBMIT BY: Wed, December 14, 2005 <br /> Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: 12470 E LOCKE RD, LOCKEFORD APN: 05132012 <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: --2O� Public Sewer: ACNP <br /> CTJ <br /> Name of wveyor Name of S stem <br /> SUMMARY OR COMMENTS: / �� ' �/� r �� � � �'� �"1" l <br /> I recommend: ApprovalEr Denial ❑ Continuance ❑ spect 'm -� <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> P) ecvt5TD SSS f,1 <br /> d t s e t� p► �.,, tan%� <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> EH 06 06 Report#7201 December 07,2005 <br />