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4 <br /> ;Iel <br /> NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0004859 <br /> DATE RECEIVED by EHD: February 25,2005 APPL#: PA-05-101 <br /> Referral Agency STAFF CONTACT: KEVIN SWANSON PE : 2690 <br /> P <br /> COMPLETE&SUBMIT BY: Pm LOT LINE ADJUSTMENT(LA) <br /> A S R 1p.� 5,do 3 l8 <br /> Assigned to • EI;0005366 MEDINA <br /> SITE ADDRESS: 100 E TADDEI RD, ACAMPO APN : 01313017&20 <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 /> r <br /> ! recommend:— Approv Denial Continuance lnsplelor <br /> Signa re <br /> Su ervisor/Lead Senior COMMENTS: <br /> o&q <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> OA it Check Off List: Proofread Report? V Correct LAND USE#? <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> EH 06 06 Report#7201 Page I March 02,2005 <br />