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i <br /> NOTE: PULL All, ERMITS (Septic, Well, etc.) MAKI a'PIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU4405091 - <br /> F <br /> DATE RECEIVED by EHD: June 15,2005 ------- <br /> APPL#: PA-0 f <br /> Referral Agency STAFF CONTACT: KARLA KUHL PE : 2690 <br /> r] <br /> LOT LINE ADJUSTMENT(LA) <br /> COMPLETE& SUBMIT BY: A r. <br /> -- Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: 9913W WALN-UT-GR.OVX D, I <br /> RNT-0–NAPN: 00114004 <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, an 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 /> Nre of Purveyor Name of System <br /> SUMMARY OR COMMENTS: / <br /> c�i7/C-� (�c� �-��:f ��Ci✓�7��'-["��f /fd� C��ia-j� •�`t��O-"7C5`J'il„�![� <br /> 76 <br /> Al <br /> [ recommend: Approval Denial ❑ Continuance El Inspe o �� <br /> Si nature <br /> Supervisor/Lead Senior COMMENTS: <br /> w <br /> ..,—� s �. <br /> SUPERVISOR/LEAD SENIOR Approvat:. Date: <br /> EH 06 06 Report 97201 <br /> June 15,2005 <br />