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NOTE: PULL ALb ..£RMITS (Septic, Well, etc.) MAKE.,.aMES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0003616 <br /> DATE RECEIVED by EHD: May 04,2004 APPL#: PA-04-213 <br /> Referral Agency STAFF CONTACT: RAYMOND HOO PE : 2631 <br /> SITE APPROVAL-MINOR(SA) <br /> COMPLETE&SUBMIT BY. C �h %� Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: 17510 N TRETHEWAY RD, LOCKEFORD APN : 05118018& <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: <br /> Name of Purveyor Name of System <br /> SUMMARY OR COMMENTS: <br /> I recommend: ApprovatC] Denial Continuance Insp ctor: <br /> ignature <br /> Supervisor/Lead Senior COMMENTS: <br /> D <br /> zz <br /> •� L 1 /".: �t,r.= �"°. art.... . <br /> _ 03 <br /> o/ <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> OA 11 Check Off List: Proofread Report? Correct LAND USE#? <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> EH 06 06 Report#7201 Page 2 May 10,2004 <br />