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i <br /> NOTE: PULL ALL*�--1tMITS (Septic, Well, etc.) MAKE t. IES FOR FILE <br />.AND USE REPORT RECORD ID: SU0006224 <br /> DATE RECEIVED by EHD: August 28,2006 APPL#: PA-0600457 <br /> Referral Agency STAFF CONTACT: KEVIN SWANSON PE : 2631 <br /> SITE APPROVAL-MINOR(SA) <br /> COMPLETE& SUBMIT BY: Wed, September 13, 2006 <br /> Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: 17310 N TULLY RD, LOCKEFORD APN : 05307003 <br /> n 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 /> tensity, location of house, wind direction, etc.... <br /> Public Water: Public Sewer: <br /> Name of Purveyor Name of System <br /> iUMMARY OR COMMENTS: <br /> recommend: Approval Denial Continuance Inspector: <br /> ignature <br />>upervisor/Lead Senior COMMENTS: <br /> u� <br /> / <br />>UPERVISOR/LEAD SENIOR Approval: Date: =/ U <br /> + , - , ,. k„ ,. <br /> 'ts` '� ofr �d e � �� �� <br /> {may <br /> M 06 06 Report#7201 August 28,2006 <br />