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NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0004767 <br /> DATE RECEIVED by EHD: January 03,2005 APPL#: PA-04-792 <br /> Referral Agency STAFF CONTACT: KEVIN SWANSON PE : 2690 <br /> e S QjI'I� LOT LINE ADJUSTMENT(LA) <br /> COMPLETE&SUBMIT BY: . — I A 1 O5 <br /> Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: 6289 S WOLFINGER RD, STOC ON ,J APN: 16211007& <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: ,yam <br /> Name of Purveyor Name of System <br /> SUMMARY OR COMMENTS: <br /> I recommend: Approval Denial ❑ Continuance ❑ Inspectl. �� <br /> SignaRure <br /> Supervisor/Lead Senior COMMENTS: <br /> 4V a s►D / ON A&c-/ 3 C4 0� ,� ,, =Q C-V V . <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> OA/I Check Off List: Proofread Report? Correct LAND USE#? <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> EH 06 06 Report#7201 Pa.-e 1 January 06,2005 <br />