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r <br /> t <br /> NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0004985 <br /> DATE RECEIVED by EHD: April 12,2005 APPL#: PA-05-199 <br /> Referral Agency STAFF CONTACT: RAYMOND HOO PE : 2631 <br /> SITE APPROVAL-MINOR(SA) <br /> COMPLETE&SUBMIT BY: Tue, May 3, 2005 <br /> Assigned to• EE0005366 MEDINA <br /> SITE ADDRESS: 25560 N HWY 99 , ACAiN1110 APN : 00514135 <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 /> N.4me of Purveyor Name of System <br /> SUMMARY OR COMMENTS: <br /> �Y <br /> i/. ' <br /> �+t]C.+C'CFlI ,... c%�-i]l!_ ''�`�t.c� ��-'.�G ✓C j'�'�""��"_l7'7d�"A�- �-�t�l! "t�.a-. ..s+�[.�o•�./ � J � Jc�, <br /> I r commend: Approval® Denial Continuancespecto <br /> �-;;7 ignature <br /> Su ervisor/Lead Senior COMMENTS: <br /> ice,,,•a/ ._.4�� �-� ,�..,-_ _�. r:..r �c <br /> o •S <br /> ZA <br /> r _ <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 �• �{ , / • �� Page 1 67, /U +Q / April 13,2005 <br />