Laserfiche WebLink
NOTE: PULL ALL RMITS (Septic, Well, etc.) MAKE PIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0004705 <br /> DATE RECEIVED by EHD: November 15,2004 APPL#: PA-04-676 <br /> Referral Agency STAFF CONTACT: KATHY ALLEN PE : 2690 <br /> ""yl <br /> , LOT LINE ADJUSTMENT(LA) <br /> COMPLETE& SUBMIT BY: ASA r ".` <br /> I IWIF " now 1 5 <br /> Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: 11930 E ST RT 12 HWY, LOCKEFORD APN : 05119036 <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 /> ern/ �t� �/-�✓J�i.. rr:13f' G�'�lr'1��i1��' Cr>• ' i- C C"CY�"5 i���✓i_��Y� .�3=t,h� <br /> 76 //Pi i " /T <br /> I recommend: Approval -/- Denial Continuance Inspector: <br /> Signature <br /> Suaervisor/Lead Senior COMMENTS: <br /> X4" or— <br /> .� <br /> ' 1 <br /> /i► it �' tea. 1� •�/ <br /> ri r o <br /> SUPERVISOR/LEAD SENIOR Approval: - Date: <br /> OA 11 Check Off List: Proofread Report? Correct LAND USE#? <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> EH 06 06 Report#7201 Page 7 November 17,2004 <br />