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' NOTE: PULL ALL �iIYIITS (Septic, Well, etc.) MAKE , _PIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0005854 <br /> DATE RECEIVED by EHD: January 03,2006 APPL#: PA-0500868 <br /> Referral Agency STAFF CONTACT: KEVIN SWANSON PE : 2622 <br /> SUBDIVISON-MINOR(MS) <br /> COMPLETE & SUBMIT BY: Tue, January 17, 2006 <br /> Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: 3200 E FOREST LAKE RD,ACAMPO APN : 00514102 <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 ❑ s e yy <br /> Sjgnature <br /> Supervisor/Lead Senior COMMENTS: Il <br /> LT L <br /> ksv/� �1.2 NSI P/lY-GtX //�i4--a0 <br /> � 1 � • 03 �G) <br /> G 22 ' 0 ) <br /> SUPERVISOR/LEAD SENIOR Approval: e: <br /> EH 06 06 Report#7201 January 04,2006 <br />