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NOTE: PULL ALv'OERMITS (Septic, Well, etc.) MAKE�OPIES FOR PILE <br /> LAND USE REPORT RECORD ID: SU0006905 <br /> DATE RECEIVED by EHD: December 11,2007 APPL#: PA-0700495 <br /> Referral Agency STAFF CONTACT: JASON JONES PE : 2622 <br /> SUBDIVISON-MINOR(MS) <br /> COMPLETE &SUBMIT BY: Tue, January 8, 2008 <br /> Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: 25660 N JACKTONE RD, GALT APN : 02102022 <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: r � <br /> Name of Purveyor Name of System _ <br /> SUMMARY OR COMMENTS: <br /> vy - <br /> C recommend: Approval Denial Continuance Inspecor: <br /> ignature <br /> Supervisor/Lead Senior COMMENTS: <br /> i <br /> o'2- P `i Pte. <br /> 11 Q <br /> SUPERVISOR/LEAD SENIOR Approval: / Date: l� <br /> (Att L'l1ct �f fs `.:e 'roorcti Retort Cotr�ctISI # r <br /> Curreet7N�1I <br /> u � ...,._ .. rx <br /> SH 05 06 Report 97201 December 24,2007 <br />