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- x <br /> ,a <br /> NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE t6PIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0004788 <br /> DATE RECEIVED by EHD: January 26,2006 APPL#:' PA-0474(REV) <br /> Referral Agency STAFF CONTACT: JOHN FUNDERBURG PE : 2611 <br /> SUBDIVISION-MAJOR(SU) <br /> COMPLETE& SUBMIT BY: Fri, February 3, 2006 <br /> Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: 26850 N LOWER SACRAMENTO RD, GALT APN : 00503007 <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 urveyor Name of System <br /> SUMMARY OR COMMENTS: <br /> 4 —= Q c �� <br /> G c <br /> I recommcnd: Approva Denial Continuance El spect <br /> ignature <br /> Supervisor/Lead Senior COMMENTS: <br /> t� <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> _. . <br /> trey p:. :.,�e� ° .._ .. <br /> EH 06 06 Report#7203 January 26,2006 <br />