Laserfiche WebLink
NOTE: PULL ALL *.. MITS (Septic, Well, etc.) MAKE %..a-eIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0005636 <br /> DATE RECEIVED by EHD: September 20,2005 APPL#: PA-04500 REV <br /> Referral Agency STAFF CONTACT: KEVIN SWANSON PE : 2656 <br /> REVISIONS TO ACTIONS (RA) <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 /> Name of Purveyor Name of System <br /> SUMMARY OR COMMENTS: <br /> I recommend: Approval F-1 Denial F-1 Continuance F-1 Inspector: <br /> Signature <br /> Sui)ervisor/Lead Senior COMMENTS: <br /> SUPERVISOR/LEAD SENIOR Approval: 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 September 21,2005 <br />