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NOTE% PULL ALtrERMITS (Septic, Well, etc.) MAKE•u6P1E$ FOR FILE <br /> LAND USE REPORT RECORD ID: SU0006004 <br /> DATE RECEIVED by EHD: April 11,2006 APDL#: PA-0600'203 <br /> Referral Agency STAFF CONTACT: KATHY ALLEN PE , 2633 <br /> SITE APPROVAL-MAJOR(SA) <br /> COMPLETE&SUBMIT BY: Tue, April 18, 2006 <br /> Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: 26590 N SACRAMENTO AVE,THORNTON APN : 00122032 <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:. w <br /> Name.of Purveyor Name of System <br /> SUMMARY OR COMMENTS: <br /> I recommend: Approval Denial Continuance n ector: c� <br /> . .., Signature <br /> Supervisor/LeaJ Senior COMMENTS: <br /> SUPERVISOR 1 LEAD SENIOR Approval: Date:90, <br /> 7 <br /> O •:1la • e Off dist:; a <br /> N _w L <br /> EH 06 06 Report#7201 April 12,2006 <br />