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NOTE: PULL ALL-.ti RMITS (Septic, Well, etc.) MAKEVOPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0004633 <br /> DATE RECEIVED by EHD: September 14,2004 APPL#: PA-04-500 <br /> Referral Agency STAFF CONTACT: KEVIN SWANSON PE : 2632 <br /> SITE APPROVAL-GENERAL(SA) <br /> COMPLETE& SUBMIT BY: Tue, October 5, 2004 <br /> Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: 24155 N ST RT 99 W FRONTAGE RD,ACAMPO APN : 00516011 <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 COMMENTS: <br /> 74Z=4Z L/���� �� �� ✓ <br /> it "�` /r/��1��'� -'����.✓"1 l <br /> I recommend: Approval Denial Continuance I pector• �y <br /> S nature <br /> Supervisor/Lead Senior COMMENTS: <br /> (� <br /> 07 PA--k d <br /> S a. <br /> C , ;o 1.11 <br /> 0 a 4V IrO7 <br /> a <br /> SUPERVISOR/LEAD SENIOR Approval: r_ Date: <br /> OA 11 Check Off List: Proofread Report? Correct LAND USE#?— <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> EH 06 06 Report#7201 Page 5 September 14,2004 <br />