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c NOTE: PULL ALt-eERMITS (Septic, Well, etc.) MAKE-w6PIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0005087 <br /> DATE RECEIVED by EH-D: June 15,2005 APPL#: PA-05 <br /> Referral Agency STAFF CONTACT: KARLA KUHL PE : 2690 <br /> '� LOT LINE ADJUSTMENT(LA) <br /> COMPLETE&SUBWr BY: �" py. Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: idim APN : 00114003 <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: �a <br /> Name_ e or Name of System <br /> SUMMARY OR COMMENTS " <br /> f Xvi�x t fit{ ae/lc C. r.r e. <br /> oe <br /> li. o6 <br /> aa, oa <br /> ii D 3 <br /> as o� <br /> I recommend: Approval Denial 0 Continuance Inspec or: <br /> Sign Lure '- <br /> Supervisor/Lead Senior COMMENTS: <br /> l4 I/ . d'6 � tejd4-'7- im-�A�eg:ft� <br /> Q3 <br /> D <br /> SUPERVISOR/ LEAD SENIOR Approval: Uatc: <br /> OA If Check Off List: Proofread Report? Correct LAND USE� ? <br /> Correct CONDI I ION(S)7_ Loggcd m LAND t' E Book? <br /> GI1 06 06 Report 87201 ..., <br />