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NOTE: PULL AL%weERMITS (Septic, Well, etc.) MAKe-dOPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0004749 <br /> DATE RECEIVED by EHD: December 15,2004 APPL#: PA-04-744 <br /> Referral Agency STAFF CONTACT: GILLIAN HAYES PE : 2622 <br /> SUBDIVISON-MINOR(MS) <br /> COMPLETE& SUBMIT BY: Tue, January 4, 2005 <br /> Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: 19260 E STAMPEDE RD, CLEMENTS APN : 01934004,05 <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: �� zs <br /> Name of Purveyor Name of System <br /> SUMMARY OR COMMENTS: <br /> aa:oa e? <br /> [ recommend: Approval ITDenial Continuance Inspect <br /> S' nature <br /> Supervisor/Lead Senior COMMENTS: <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> its <br /> z <br /> 10 <br /> W� � n <br /> e . <br /> _., d.. ... -4xan n.a ... t r:. .. e�d.. x,y„x '�dra+. <br /> EH 06 06 Report 47201 Page 3 /����� December 16,2004 <br />