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NOTE: PULL ALL PE—WITS (Septic, Well, etc.) MAKE MOOS FOR FILE <br /> AND USE REPORT RECORD ID: SU0005078 <br /> DATE RECEIVED by EHD: May 31,2005 APPL#: PA-0500289 <br /> Referral Agency STAFF CONTACT: GILLIAN HAYES PE : 2631 <br /> SITE APPROVAL-MINOR(SA) <br /> COMPLETE& SUBMIT BY: Tue, June 21, 2005 k: <br /> Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: 24155 N ST RT 99 N FRONTAGE RD, ACAMPO APN : 00516011 <br /> n completing the Land Use investigation, draw all Public Health factors on the exhibit (i.e., sewage disposal, water <br /> upplies, etc...). Where necessary, on an attached piece of plain paper, draw complete map of area showing population <br /> lensity, location of house, wind direction, etc.... <br /> :'ublic Water: �GJy Public Sewer: <br /> --T Name of Purveyor Name of System <br /> :UMMARY OR COMMENTS: <br /> O� <br /> Tc� �=�r�i-moll � -�-�ryP�i r�,�/,✓��i/ �� c�,l'��� �4/�, <br /> I recommend: Approval Denial Continuance <br /> S lure <br /> Supervisor/Lead Senior COMMENTS: <br /> D , <br /> .E <br /> SUPERVISOR/LEAD SENIOR Approval: Date: Z3 JJ <br /> OA 11 Check Off List: Proofread Report? Correct LAND USE#? !� <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> n <br /> EH 06 06 Report 47201 <br />