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NOTE: PULL ALL*-..:RMITS (Septic, Well, etc.) MAKE . jPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0004583 <br /> DATE RECEIVED by EHD: July 20,2004 APPL#: PA-04-400 <br /> Referral Agency STAFF CONTACT: JOHN FUNDERBURG PE : 2631 <br /> SITE APPROVAL-MINOR(SA) <br /> COMPLETE& SUBMIT BY: Tue, August 3, 2004 <br /> Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: 20101 N SIERRA DR, LOCKEFORD APN : 01937032 <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 /> s Ap <br /> I recommend: Approval Denial ❑ Continuance Insp t0 <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> D <br /> 8. 2o : oY <br /> C. lyy. al <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 Pagc K July 27,2004 <br />