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NOTE: PULL AL-yERMITS (Septic, Well, etc.) MAKE�PIES FOR FRE <br /> LAND USE REPORT _..__ RECORD ID: SU0008039 —_,. <br /> DATE RECEIVED by EHD: December 23,2009 APPL#: PA-0900296 <br /> Referral Agency STAFF CONTACT: JOHN FUNDERBURG PE : 2690 <br /> LOT LINE ADJUSTMENT(LA) <br /> COMPLETE&SUBMIT BY: ASAR <br /> A.d�-hr-- <br /> Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: 9701 W WALNUT GROVE RD, THORNTON APN : 00114007 43 44 <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 /> I recommend: Approval Denial Continuance In pector': <br /> Signature <br /> Sunervisor/Lead Senior COMMENTS: <br /> 0 \ <br /> I <br /> SUPERVISOR/LEAD SENIOR Approval: Date: I <br /> OA ll Ctieclr Off Lf.!Ei Pr©ofrcad Rcport? rre t L t 3 SE <br /> -OR <br /> J.ogped In, SSE"Bpok?' <br /> EH 06 06 Report#7201 <br /> December 29,2009 <br />� If <br />