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NOTE: PULL ALL�eRMITS (Septic, Well, etc.} MAKE 1f.. 'PIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0006032 <br /> DATE RECEIVED by EHD: May 09,2006 APPL#: PA-0600243 <br /> Referral Agency STAFF CONTACT: ANTONIO SALCEDO PE : 2622 <br /> SUBDIVISON-MINOR(MS) <br /> COMPLETE&SUBMIT BY: Tue, .tune 6, 2006 <br /> Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: 19267 E STAMPEDE RD, CLEMENTS APN : 01934013 <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: �,�,p Public Sewer: <br /> Name of Purveyor Name of System <br /> SUMMARY OR COMMENTS: ��n� <br /> as �� <br /> sr.•n �- <br /> The Ag-Well located on Parcel #1 shall not be supported by the EHD for a domestic <br /> water source. The EHD does not have a permit or record of the well construction. <br /> I recommend: Approval ® DenialEl Continuance Inspe or: , <br /> Sig ature <br /> Supervisor/Lead Senior COMMENTS: <br /> 11II /.. <br /> rc a a ✓e _ � A`Fs- - o a. <br /> - i <br /> 4'4J [ <br /> . rr 0 3 ct. . <br /> SUPERVISOR I LEAD SENIOR Approval: Date: /f-/Q 6 <br /> a T. XQff L1st Pr"oafreaRBport? x 'Correct L SNI]°UL <br /> C"rreet GQNDITION{5) .- ' ; Logged m LAND UEaBook? P : <br /> F kl <br /> 61106 06 Report 47201 May 09,2.006 <br />