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.1 <br /> ' - NOTE: PULL ALL,.:RMITS (Septic, Well, etc.) MAKE, PIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0004584 <br /> DATE RECEIVED by EHD: July 22,2004 APPL#: PA-04-407 <br /> Referral Agency STAFF CONTACT: KATHY ALLEN PE : 2690 <br /> LOT LINE ADJUSTMENT(LA) <br /> A4.q A <br /> COMPLETE& SUBMIT BY: <br /> Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: 19260 E STAMPEDE RD, CLEMENTS APN : 01934004&05 <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 /> f <br /> 11 <br /> I recommend: Approval, Denial Continuance Inspector: <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> is <br /> I� <br /> 7 <br /> I: <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> OA It Check Off List: Proofread Report'? CorrectL ND USE 7 <br /> J' <br /> Correct CONDMON(S)7 Logged in LAND USE Book? <br /> EH 06 06 Report 47201 ' Page 9 July 27,2004 <br />