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C <br /> NOTE: PULL ALLY.,ZRMITS (Septic, Well, etc.) .MAKE*..PIES FOR FILE <br /> LAND USE REPORT RECORD I.D: SU0005727 <br /> DATE RECEIVED by EHD: October 26,2005 APPL#: PA-0500724 <br /> Referral Agency STAFF CONTACT: JOW FUNDERBURG PE : 2690 <br /> LOT LINE ADJUSTMENT(LA) <br /> COMPLETE&SUBMIT BY• jr <br /> Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: 22550 N THIRD ST, CLEMENTS APN : 01924051 <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: 1-1 zo Public Sewer: z22-0 _ <br /> Name of Purveyor �^ Name of System <br /> SUMMARY OR COMMENTS: <br /> ' Sim <br /> d <br /> I recommend: Approval Denial Continuance Ins ector• <br /> ' nature r <br /> SupervisorfLead Senior COMMENTS: <br /> CJ f�j <br /> 1-7 <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> Proofrea e iwN� <br /> M <br /> ffi'�t <br /> �orrec�K <br /> ���€ �� � !-QLeE(; - :� � �t l ,;h�:°� � ......i..` .. .r..»°.tis :n, sw, z. .at . <br /> EH 06 06 Report#7201 October 27,2005 <br />