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NOTE: PULL ALL'PERMITS (Septic, Well, etc,) MAKE COPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0004788 <br /> DATE RECEIVED by EHD: January 20,2005 APPL##: PA-04-74 <br /> Referral Agency STAFF CONTACT: JOHN FUNDERBURG PE : 2611 <br /> COMPLETE&SUBMIT BY: Wed, January 20, 2005 SUBDIV[STON-MAJOR(SU) <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 of Purveyor Name of System <br /> SUMMARY OR COMMENTS: <br /> recommend: Approva Denial Continuance Insp t <br /> S gnature <br /> Supervisor/Lead Senior COMMENTS: <br /> c e 1Z <br /> d <br /> JL@429�v OIL <br /> • U <br /> V <br /> SUPERVISOR/DEAD SENIOR Approval: Date: <br /> OA R Check Off List: Proofread Report? Correct LAND USE# <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> EH 06 06 Report#7201 Page 6 January 21,2005 <br />